I beg to move,
That this House
condemns the Government's failure to address the crisis facing care homes for the elderly, which has resulted in the closure of a large number of care homes, with damaging consequences for the sector and for many other aspects of the work of the NHS;
remains concerned that the combined impact of the levels of fees paid to care homes by local authorities and the National Minimum Standards will continue to have an adverse impact upon small to medium size care homes in particular, leading to further losses in capacity;
regrets that the terms under which the Government introduced 'free nursing care' on 1st October 2001 differ very markedly from those laid out when the draft legislation was under consideration;
deplores the increase in the number of elderly people receiving inappropriate care and the large number of hospital beds being blocked and operations being cancelled because of the loss of care home beds into which to discharge hospital patients once their treatment has been completed;
and calls on the Government to recognise the damaging effects of this crisis in care on the most vulnerable members of society and swiftly and decisively to end the suffering, disruption and distress that is being caused to the elderly by the Government's policies.
Society, and each and every one of us, has a duty to ensure that the most vulnerable groups in our community are properly looked after and that they are entitled to a high quality of life, with dignity and proper care. One of the most vulnerable groups in our society are the elderly—many of them frail or infirm, often alone, sometimes confused and frequently worried about their ability to cope and look after themselves.
Society owes a debt of gratitude to the dedicated people who spend their time and energies looking after those highly vulnerable members of our community, and who devote their lives to enhancing the quality of life of the elderly, and ensuring that they receive the best quality care available and that their homes are indeed "home from home."
That is why it is so distressing that the Secretary of State for Health expressed the Government's contempt for care homes and the excellent care that they provide when he referred in the House on
The Secretary of State and his Ministers may be in a perpetual state of denial, but the sad fact of life is that care of the elderly in this country is in crisis. As the Coalition for Care recently said:
"Private home owners are on their knees and facing widespread bankruptcy."
The care home sector has lost more than 2,000 homes—nearly 15 per cent.—and more than 8 per cent. of its capacity since 1997, and there is no sign of care home closures abating. Meanwhile, despite Government promises to help the elderly to live independently, the number of people receiving care in their own homes has declined by 12 per cent. over the past five years.
The Minister of State, Department of Health, Jacqui Smith, seems to disagree. I remind her that the number of people receiving domiciliary care has declined, although the hours that they receive have increased. Ironically, as the supply of care is dramatically reduced, demand is set to increase radically. We are approaching the stage where families might even have two generations needing care. That reflects the fact that the number of elderly people in Britain is growing rapidly.
In particular, the number of very elderly—the over-85s, who require the most care—is rising the most rapidly. In 1952 there were 500,000 people over 85. This year there are 1.2 million, and in the next decade the number of over-85-year-olds will increase by a further 250,000.
One of the greatest threats to long-term care has been the dramatic closure of homes. Both residential and nursing homes have been hit heavily. Indeed, there were more than 2,000 fewer care homes in 2000 than in 1997, with areas such as the south-west and London and the south-east being particularly badly affected.
Sadly, my hon. Friend is right. His example typifies the problem, which I shall elaborate on shortly. That is happening all over the country, as a result of the closure of homes.
Small homes have been particularly badly hit and the effect of this trend has been greatly to reduce the choice of homes for elderly people, who as a result have to be moved further and further away from where their homes were, and where their families and their friends are. These closures have inevitably resulted in a radical and unprecedented decline in the supply of long-term care places. All over the country, homes are closing and are being lost.
If the hon. Gentleman will allow me to make some progress, I shall give way in a moment.
To give the House some idea of the magnitude of the problem, in the Secretary of State's constituency, Darlington, over the past 18 months, 17 homes have closed, with 499 beds lost. In the region represented by both the Minister of State, Department of Health, Mr. Hutton, and the Under-Secretary of State for Health, Ms Blears, the number of beds fell by 18 per cent., with a loss of almost 5,400 beds over the past four years. In the region represented by the Minister of State, the hon. Member for Redditch, the number of beds fell by 10 per cent., with a loss of almost 2000 beds. In the region represented by the Under-Secretary of State for Health, Mr. Lammy, the number of homes fell by 21 per cent., with a loss of 1,350 beds. Since 1998 in the constituency of my hon. Friend Mr. Brady, 29 residential and care homes have closed, with a loss of 1,683 beds.
The hon. Gentleman makes a strong case for the quality of care in the private sector. I agree with him, but there is also excellent public sector care. However, is he seriously suggesting that the only form of care that we should support for older people is residential care? Surely there is a duty on the part of people who work in residential care to work in clear partnerships with local authorities and health departments to produce new models of flexible care.
I am certainly not saying what the hon. Gentleman suggests. He can rest assured that I shall shortly deal with his county, Lancashire.
Sadly, the future looks bleak. A survey that I have carried out over the past two weeks suggests that there is no abatement in the pressures forcing homes to close. Cheltenham, which has already lost 700 beds, is facing a further six home closures. BUPA is carefully considering two of its homes; Devon is losing its last two nursing homes; and three homes are in the process of closing in Kirklees. Reading is facing the closure of a 48-bed home by its own local authority, and South Shropshire has 12 homes under threat of closure. To answer Mr. Dawson, Lancashire is considering closing all its 32 care homes. Mr. Prentice, whom I am glad to see in his place, said in this House on
"tremendous anxiety for the many elderly people in my constituency. They . . . are fearful about what is to happen."
He went on to say:
"We read . . . of people's despair about the proposed closures, yet the area has a Labour MP, a Labour Government, a Labour district council and a Labour county council, so no one else's fingerprints are on it."—[Hansard, Westminster Hall, 26 February 2002; Vol. 380, c. 177WH.]
Sadly, the hon. Gentleman is correct: the closures indeed bear the fingerprints of this Labour Government. They are all over them, and like a rabbit blinded in the headlights of an oncoming car, this Government do nothing except bandy around disingenuous statistics.
If we are going to talk about statistics, the truth is that the overall number of beds lost in this country since 1997 is 46,700—a loss of more than 8 per cent. of capacity in only five years. Independent research commissioned by the Labour-dominated Select Committee on Health has confirmed those figures, which coincide with those produced by an equally independent source—Laing and Buisson.
Does my hon. Friend also realise that the Labour Government's fingerprints are to be found in Conservative Market Harborough? Lenthall House, a Leicestershire county council home, is threatened with closure as a direct result of this Government's policy of introducing what they ludicrously call "best practice". Several people will be thrown out of the home during the next few months if the policy is allowed to stick.
My hon. and learned Friend describes a problem that is sadly all too well known throughout this country, as more and more homes are being closed and beds lost because of the actions of this Government.
I will just make the point about the figures, and then I will move on to the hon. Lady.
Some of those beds have been lost in the independent sector, and the figure also includes 26,000 lost in the public sector: 13,500 from local authorities and 12,500 from long-stay NHS provision.
I thank the hon. Gentleman for giving way. I remind him that he supported the implementation of the National Health Service and Community Care Act 1990 under the previous Conservative Government, who said that too many people were in residential care and would be better supported in their own homes. Is he now saying that they got it wrong?
No, I am not. What I am saying is that this Government are hitting those people with a double whammy: they are closing the homes, the beds are being lost and the amount of domiciliary care provided has declined by 12 per cent. The hon. Ladies on the Labour Back Benches nod their heads in chorus, but they do not listen. The number of people getting domiciliary care has fallen since 1997. The number of hours that they are receiving has risen, but the total number of people who are getting the care has been cut.
To return to the figures, the Government keep claiming that the overall number of beds lost is 19,000, but in the true spin mode to which we are all accustomed, they seek to massage bad news and have used a different and highly disingenuous basis for calculating those figures. To try to massage that bad news, they have used a different period and a different basis for their calculations. Their figures are based solely on the independent care homes sector and exclude the beds lost from local authority and NHS provision. Remarkably, they totally exclude any figures for 2001. As if that were not enough, they use a late year base of November-December for their figures, rather than the year ending in March-April.
For the NHS, the closures are having serious consequences on delayed discharges from hospitals. The total number of delayed discharges is still above the 5,000 level, and a growing minority of delayed discharge patients are staying longer in hospital, with more than 36 per cent. staying for more than 28 days. The knock-on effect is that the number of cancelled operations is rising, as it has done each year since this Government came to power. More worryingly, the rate for readmission within 28 days of discharge is rising and is especially high for over-75s. It is also worrying that a number of trust chief executives are again beginning to see rising pressures in terms of delayed discharge. They are all fearful that further anticipated home closures will significantly and adversely affect their ability to reduce the numbers in the next 18 months.
Another reason for the problems facing care homes is fee levels. The Joseph Rowntree Foundation highlighted the fact that the average cost per week for nursing care of older people in a home is £459, and that the cost for residential care is £353. Those costs are about £75 to £85 higher than the average fees paid by local authorities. In addition, there is the looming problem of the estimated £300 million increase in national insurance contributions from next April, which will be a crippling blow to the sector.
The hon. Gentleman has been speaking for a very long time, but if I were a Conservative supporter, I would still be wondering which way to vote; I would want to know what he was going to do about the problem.
The hon. Gentleman must think the House is stupid if he expects us to believe that he is still thinking about how to vote. We all know that, like every other clone in the Labour party, he will be voting with the party tonight, in defiance of what is going on in this country.
Ironically, it is estimated that local authorities are paying fees to place residents in their own homes that are up to 40 per cent. higher than they pay in the independent sector. That is unfair, it is a short-term catastrophe and it is one of the major contributing factors to the closure of care homes, and especially the small and medium-sized ones.
A significant number of self-funding residents are now in effect subsidising local authority-placed residents. The Government's introduction of free nursing care is doing very little to help to reduce the problems that were identified before that happened.
No; I need to make progress.
Another major factor in home closure has been the mass of regulations imposed on care homes and the unsatisfactory manner in which they are being implemented, despite the promise of a carrot rather than stick approach. The Prime Minister seems rather confused about the implementation of the new care standards. My hon. Friends will remember that, last Wednesday in Prime Minister's questions, he told my right hon. Friend the Leader of the Opposition that the care standards regulations
"do not come into effect until 2007."—[Hansard, 3 July 2002; Vol. 388, c. 221.]
He was quite dogmatic about that—and he is equally wrong. Let me explain to the House what his Government are doing.
There are 38 minimum standards covering seven topics and comprising 246 individual rules. Two provisions will operate from 2004 and four provisions will operate from 2007, but what the Prime Minister does not seem to understand is that 240 provisions operated from
Of course, everyone supports the principle of raising standards and the quality of care but it must be done in a sympathetic, sensible and sensitive way.
I am glad that my hon. Friend has raised the answer that the Prime Minister gave last week. The figures that my hon. Friend has just given us were confirmed to me this morning by the House of Commons Library. Given all the regulations that they have had to implement from
Sadly, my hon. Friend is absolutely right. One of the major problems facing the care homes sector is what is going on as a result of the Government's policies and their lack of preparedness to take action to rectify the problem.
No, I will not give way. I am going to make progress.
Some of the requirements in respect of room sizes and other structural changes are unnecessarily over- prescriptive and ludicrous. [Hon. Members: "Name them."] If hon. Members listen, I will. For example, one large care home provider with more than 200 homes told me that the standards require doors in the homes to be a minimum of 80 cm wide, but the doors in the homes happen to be 78 cm wide and it will cost £2.5 million to meet the required standards.
A care home owner in East Sussex who has been running her home for 18 years told me:
"The inspector said the rooms were the wrong size and the social needs of the residents were not being met because not every resident was taken out every day."
Ironically, many of the residents chose their own rooms as they were happy with their size and
"preferred a smaller and more cosy room to a large vacuous one."
[Interruption.] Labour Members laugh, but that is what the residents of care homes want. All Labour Members can do is laugh at their wishes.
The owner was left in tears by the inspectors. She said that she was left feeling
"undermined, undervalued and demoralised by them".
Her home now has to close because she cannot afford to meet the minimum room size standards. She told the inspectors that the next time they visited she would be working in Tesco's.
A home owner in North Tyneside told me that his family had run their home for 31 years and had been highly regarded for providing high-quality care. Now they are having to close, with the loss of 21 beds, because they cannot run the home on the occupancy levels that the new standards will mean.
A home in Kent for elderly people with learning disabilities, which has 32 beds, will be closing in August because of the upgrading requirements in the care standards regulations. One resident has been there for 35 years. The uncertainty and confusion of residents at having to leave their home is causing shock and deep distress. The manager has said that 95 per cent. of those residents have no family, relatives or friends, and regard the staff as their family. Their lives and security will be destroyed.
No, I will not.
Another home owner, in Somerset, said of the Government's over-regulation:
"It's not about care anymore—it's about bureaucracy. They don't care! It broke my heart to close my home and move my residents out."
Why did she have to move them out? Because she was required to install a lift to accommodate five people, even though she only had a seven-bed home. She lamented to me:
"One elderly lady phones me all the time saying how unhappy she is and misses the home. She tells me 'this isn't my home.'"
That quote sums up the deeply distressing impact the Government's policy is having on so many elderly vulnerable people.
Even the constituency of the Minister of State, the hon. Member for Redditch, is affected. She may be familiar with the Stonebridge nursing home, with 41 beds. The Minister nods; she is clearly familiar with it. I wonder how good her memory is.
The Minister is very good at memorising things, so I hope that she remembers what I am about to tell her.
"Under a Labour Government, bureaucracy would decrease".
Mrs. Jones notes with some dismay that since 1997 the opposite has happened. The home even had to employ an extra member of staff to deal with questionnaires and forms from the National Care Standards Commission and the inspectors. As the Minister said, the home has applied for planning permission. Of course it has—to comply with the care standards and to make the necessary changes. It will cost the owner £350,000 to do so.
The distress and the disruption to vulnerable people's lives caused by the impact of these regulations is totally unacceptable and in many cases totally unnecessary. There is no point in Ministers chanting the mantra that the inspection teams have been instructed to work in a sympathetic and sensitive way, because in the real world—not in the ivory tower of the Department of Health—that is not happening. Too many elderly, frail and confused residents are seeing their homes and security destroyed in an act of bureaucratic vandalism. No one would disagree with the need to raise standards where that is necessary or to enhance the quality of life of residents, but Ministers cannot and must not hide behind that to allow elderly people's lives to be ruined and destroyed in the name of heavy-handed bureaucracy.
Quality care is not provided by enforcing arbitrary bureaucracy. Quality care is not provided by officious inspections. Quality care is not provided by pretending that there is not a crisis. There is a crisis in care—a crisis for the elderly, a crisis for the defenceless, a crisis for the frail and a crisis for the vulnerable. They deserve better, but the Government are failing them. It is time for the Government to listen, to take note and to act now.
I beg to move, To leave out from "House" to the end of the Question, and to add instead thereof:
'welcomes the Government's strategy for modernising social care services through unprecedented real terms increases in resources;
condemns the Opposition for opposing this investment;
welcomes the improved joint working between the NHS, social services, and the independent care sectors which has seen a reduction in levels of delayed discharges of over 1,000 since September 2001;
recognises Government action to provide real choice for older people in long term care and to place a greater emphasis on users and patients in the design and delivery of services;
notes the confusion, inconsistency and lack of independence in previous registration and inspection regimes and welcomes the Government's national framework for standards and quality;
further notes that the extra funding is enabling local councils to increase fees paid to care homes and that providers are continuing to open new homes;
and recognises that the number of people receiving intensive home care support is increasing, enabling more people to live independently at home for longer.'.
Improving services for older people is one of the Government's highest priorities. For that reason, I welcome this debate, which provides an opportunity to discuss how we deliver the right type of care and support for older people at the right time and in the right setting, whether that setting be a care home, sheltered accommodation or assisted living within a person's own home. Ensuring choice and good quality care for vulnerable people is about more than care homes.
I also welcome today's debate as I can share with Mr. Burns my respect and praise for those who work in all our care settings for the contribution that they make to vulnerable people. I will focus on care homes, not least to counter some of the disinformation and scaremongering that have characterised the hon. Gentleman's contribution. The old and vulnerable people who depend on our care system deserve more than that.
I am grateful to the Minister for giving way at this early stage. During this debate, she will have heard interventions from the hon. Members for Blackpool, North and Fleetwood (Mrs. Humble) and for Lancaster and Wyre (Mr. Dawson), and she will be aware of the concern that the hon. Members for Preston (Mr. Hendrick) and for Pendle (Mr. Prentice) and I have about Lancashire county council's proposals to close 35 of its 43 care homes. The Minister said that she would keep in close touch with the county council and monitor that situation. Will she now tell us precisely what she has done, and what comfort she can bring to the elderly people of Lancashire with regard to the actions of this Labour-controlled council?
The right hon. Gentleman is right—my hon. Friends have taken a close interest in care homes in Lancashire. I have, as I said I would, asked the social services inspectorate to keep a close eye on the matter, and the inspectorate has worked with the local authority to secure a better relationship between the independent care sector and the local authority than there had previously been, as was rightly argued for by my hon. Friend Mr. Dawson.
Some people will continue to need and choose residential and nursing care. We need to continue to build a system that translates the needs and choices of older people into the commissioning of a suitable range of both residential and other options for long-term care. This approach puts older people and their choices at the centre of planning. Unfortunately, our long-term care has not always been planned in that way.
May I draw to my hon. Friend's attention a survey that Age Concern Cymru has just given to me, which illustrates that 40 per cent. of people in residential care suffer from clinical depression? Will she bear in mind, when she talks about choices, what people really want is to be supported in their homes?
My hon. Friend makes an important point about the choice and the independence that we need to provide for older people, and I shall explore that subject later.
As I was saying, we have not, unfortunately, always planned our long-term care by putting older people's needs at the centre. There was a huge expansion in the number of care homes throughout the 1980s, when uncapped budgets from the then Department of Health and Social Security were available for publicly funded people entering residential care. Entry to a care home was not based on need or user choice, but was too often driven by the interests of providers and, more significantly, by Government dogma. Profits were high but the standard of care was too often too low. Indeed, it has already been pointed out that it was the Conservatives—then in power—who, having created this unplanned and uncontrolled growth, sought severely to limit it. As I recall, the National Health Service and Community Care Act 1990 was introduced as much to stem this flow of money as it was to improve the lot of those using public services.
If it is true, as the Minister says, that there was an explosion in the number of homes in the 1980s—and, therefore, an explosion in the amount of money following those homes—will she take the time to tell that to her colleague the Under-Secretary, Mr. Lammy, who made his first ministerial visit to the west country the other day? When he was confronted with the problems of Devon care homes closing, he replied that that was due to 18 years of chronic underfunding.
My point—and that of my hon. Friend the Under-Secretary—is that decisions were made on the basis of funding streams; they were not made on the basis of investment in assessment and real care for older people, which is what this Government have done.
Fuelled by huge expansion in the 1980s, the care home market peaked in 1996, when there were too many beds to be sustainable in the long term. Indeed, a recent report by the Joseph Rowntree Foundation, written by Mr. William Laing of the independent care consultants Laing and Buisson, states that
"a decline in care home capacity was to be expected—and, indeed, broadly welcomed."
I was quoting the Joseph Rowntree Foundation, rather than myself. I was, however, going to go on to say that I recognise the concerns that come with managing this change in the care home market. As hon. Members have heard me say on numerous occasions, there has been a small loss of care home beds since 1997—[Interruption.] Some Conservative Members continue—because they lack the sophistication of the hon. Member for West Chelmsford—to chant about 50,000 care beds being lost.
I will give way in a moment.
Although 50,000 beds were deregistered, more than 31,000 beds entered the care home market during the same period, making a loss of just 19,000. That is just 4 per cent. of the stock, which means that there is roughly the same number of care homes today as there was in 1997.
If the hon. Gentleman had been a little less excited about jumping up, he would have heard me say that there had not been a loss of 50,000 care beds, but a net loss of 19,000. I also said that I was concerned about that. These are the facts—not according to the Department of Health, but according to Laing and Buisson, which Conservative Members are so keen on quoting.
Conservative Members have proved to me today how difficult it is to get the message over to the Opposition. I have outlined these figures to the hon. Member for West Chelmsford across the Dispatch Box on numerous occasions, and I went through them with him step by step at the Select Committee on Health. Either Conservative Members are very slow learners, or they have decided not to let the facts get in the way of a political campaign, which is a pretty cheap way of treating the older and vulnerable people who need us to have an informed debate and put forward practical suggestions for improvement.
Does the Minister accept that in rural areas such as my constituency in Devon, geographical spread and availability are important to choice? In many of my larger villages, there is only one residential home. If that home closes, the people in that local community will have to live much further away from their friends and relatives. We are going to end up with Trust House Forte-style care homes with colour co-ordinated bedrooms in urban areas—[Interruption.] It is happening now, and people in rural areas have no choice but to be divorced from their local communities.
I understand the hon. Lady's concerns about care homes in rural areas. As I was about to say, we need to ensure that the fees paid to them reflect their operating costs. I shall come to fees in a moment; I am looking forward to doing so.
On the point made by Conservative Members about delayed discharge, is it not time that we looked at new ways of dealing with that issue? The Moorlands Grange home in Netherton, which my hon. Friend the Minister visited recently, is now an assessment centre. People stay there for a limited period, often a period of their own choosing, while they decide for themselves whether they want to go into a care home or return home with some support. Would that not be a better way of dealing with this problem?
My hon. Friend is right, and I enjoyed my visit to her constituency. That kind of practical suggestion and positive forward thinking will get us so much further than a slanging match about statistics. Of course, any closures that result in people having to move are worrying for those people and their families. I understand that at first hand, not least as a result of a campaign that I ran, before being elected to Parliament in 1997, to prevent the Conservative-controlled Worcestershire county council from closing a home in my constituency. We won that battle, and I was delighted to open the upgraded home just a few weeks ago.
If we are to maintain the necessary care home capacity and provide new services, of course we will need investment. Fees must reflect the costs of residential and nursing care and the improvements that we want.
Issues other than fees may arise in relation to the introduction of new standards in various parts of the country. Tonight's tragedy, however, is that given the tone set by the uninterrupted rant from Mr. Burns, the House has lost any opportunity to recognise the existence of geographical differences—differences relating to fees, but also to how zealously standards are interpreted. There is room for debate about such matters, but that earlier rant has obscured it.
This is tricky territory for Conservative Members. The fees paid by local authorities depend on how much they receive. The amount has risen by more than 3 per cent. a year in real terms since 1997; it rose by only 0.1 per cent. a year under the Conservatives. Moreover, we recognised the concerns of local government last year—
No. I have already been far more generous than the hon. Member for West Chelmsford, and I want to make some progress.
As I was saying, we recognised the concerns of local government last year. Over that year and this, we have provided £300 million to help stabilise the care market and cut the number of delayed discharges. I have been asked where the money went. More than 50 per cent. of what councils received was spent on care homes. It is because of those additional funds that local councils have been implementing fee increases. According to independent care consultants, the vast majority of councils recently agreed to fee increases in excess of 3 per cent., and some have agreed to much bigger increases. A third of them have increased fees by more than 10 per cent.
Gregory Barker spoke of problems in East Sussex. My hon. Friend may be interested to learn that while her generosity and that of her colleagues was welcomed by those in East Sussex who received an extra £1.2 million, the Tory county council cut its social services budget by £4 million, thus taking more out than the Government put in.
My hon. Friend has ably illustrated the Conservatives' attitude to investment. I spoke of difficult territory; even more difficult for them to accept is the fact that we are committing resources in the long term. I said that funds for social services were rising by 3 per cent. over inflation each year. As the Chancellor announced in the Budget, from next April we will double that, delivering an average real-terms increase of 6 per cent. a year from 2003–4 to 2005–6. That is very good news for those who need the support of care services—and, as reaction to the Budget has shown, there is overwhelming public support for the extra investment. It is a pity that the Conservatives do not feel the same; it is a pity that they voted against that investment on
I have considerable sympathy with the Minister's argument, and I support the Government's aim of improving care home standards. Let me point out, however, that in forthcoming years not private homes but local authority homes will find it most difficult to meet those standards because, for reasons that the Minister has given, they have suffered from underinvestment for many years.
Will the Minister say something about the Welsh Assembly's call for the Government to make personal care freely available in Wales?
I shall deal with the issue of care standards later but, as the hon. Gentleman says, investment is important.
I think that we have made our position clear. We think it important to ensure that there is free nursing care, but also to provide new services by means of the extra investment we are making. Decisions being made in Wales are of course a matter for Wales, and I know the hon. Gentleman takes a close interest in them.
Money is important, but so is better commissioning of care for older people. The ad hoc and distorted relationships of the past are being replaced by partnership at local level between health organisations, social services organisations and the independent and voluntary sector. We have established a new, more positive partnership between the statutory and the independent social, health care and housing sectors at national level. That is being built on locally as authorities implement our agreement, published as "Building Capacity and Partnership in Care".
We need a whole systems approach. The care home sector does not exist in isolation from the overall health and care economy and the reforms that are happening elsewhere. Councils, care home providers and others need to get round the table, listen to what older people say they want in the future and work together to commission and provide it.
Once again, we are focusing on the issue of standards for care homes. Standards in that sector are not new. The system of standards introduced by the present Government replaced a system under which care homes were regulated by about 250 local authorities and health authorities, each applying its own standards. The old regulatory system had been criticised for many years for lacking independence, consistency and coherence. Many people, not least members of care home provider organisations, have been calling for national standards for some time. We responded to those calls: we outlined our proposals in the White Paper "Modernising Social Services", we consulted widely and we debated the proposals at length in Parliament. The Conservative party supported them.
I have spoken to care home owners who are worried about meeting some of the standards. We have already acted on that and will continue to listen. The more challenging environmental standards will not be implemented until 2007 and providers will be given realistic timetables to meet them.
I am sure that my hon. Friend heard Mr. Burns criticise the care standards that have been introduced. The hon. Gentleman did not, however, list the standards that he would not implement were he in a position to do so. Has my hon. Friend managed to secure such a list from him, and has she been able to assess the effect on care for the elderly if those standards were not implemented?
My hon. Friend makes an important point, to which I shall return shortly.
In January I issued instructions to the National Care Standards Commission to ensure that inspectors consider whether care homes could fulfil the needs of service users without making environmental changes—for instance, to room sizes, lifts, baths and shared rooms—to meet the standards. I made it clear that failure to meet them should be used as a reason to deregister a home only when services posed a danger to vulnerable people. We believe that people's safety and well-being is paramount and the new standards will help to ensure that poor quality care is a thing of the past.
It is true that only one of the seven categories of standard is environmental. I have mentioned our common-sense approach, but I make no apology for the expectation that those who care for our most vulnerable people should have some training; that those going into homes should have information about terms and conditions and a plan of care; that they should be given regular nutritious meals; and that medicine should be controlled and supervised. If Conservative Members cannot support those standards, I hope that they will explain why to the families of vulnerable people in their constituencies.
May I make a constructive point? It is being said in my area that inspection is being rigorously enforced in some parts of the country, but not in others. Will the Minister pay serious attention to that? It seems that in some regions standards to which the Minister committed herself are being implemented sensibly, while in others, such as mine, they are being implemented too zealously.
The hon. Gentleman makes a sensible point. Of course, we need to continue to work with the National Care Standards Commission to ensure consistency in the way in which inspectors operate.
The emphasis in the standards will be on ensuring people's safety. Of course, there is a balance to be struck. Our aim is to set standards at a level that will improve the quality of life for people whose home is a care home. We will continue to watch developments carefully and—as we have done to date—we will not hesitate to act if we become convinced that the balance is wrong.
No, it is time for me to make some progress.
Long-term care is not just about care homes; increasingly, older people want to be able to choose to stay at home. We are giving them that independence through the development of alternatives such as extra care housing and the provision of more intensive home care packages to keep people in their own homes for longer. Since 1998, the number of intensive home care packages—people supported in their homes, in many cases instead of through residential care—has increased by nearly 16,000. Intermediate care services are making a difference to the independence of, and choices available to, older people. "Hospital at home" teams can give antibiotics to older people with chest infections in their own homes, rather than their having to be admitted to hospital. The other day, I met a lady who thought that she would have to go into a home following a hip replacement, but instead she was receiving intensive rehabilitation in an intermediate care centre that was developed within a care home. She was already making plans to go back to her flat. The plans for intermediate care that are spelt out in the NHS plan are becoming a reality for thousands of people.
New services and investment are achieving results. The issue of delayed discharges was raised, and I am pleased to announce that significant progress has been made in respect of the serious problems that the Tory Government left us. The rate of delayed discharges for patients aged over 75 stood at 13 per cent. in March 1997. In other words, nearly 7,000 older people were stuck in hospital when they should have been discharged. By March 2002, that figure had fallen to 9.4 per cent.—nearly 2,300 fewer. With investment and reform, we are ensuring that more vulnerable people get the right care in the right place, and at the right time.
This evening, we have been treated to the latest incarnation of compassionate conservatism. That is quite a transformation for the hon. Member for West Chelmsford, given his record in government. However, he has also allowed us to see what compassionate conservatism really means. It can be summed up in three easy sentences: "We're sorry that there are social problems and challenges for our public services. We're really sorry that we were responsible for causing them. Sorry, but we're not going to do anything to put them right."
What the people who depend on our care services really need is not Conservative crocodile tears, but a Labour Government who are providing more investment, higher standards, more services, more choice, more independence and more hope for the most vulnerable people in our society. I commend the amendment to the House.
I want to begin by referring to some of the evidence—perhaps the Minister did not wish to hear it this evening—on the crisis in the care system. The reality is that the problems from which care homes, home care and the care system in general are suffering have been well documented not just by political parties in this House but by organisations such as Help the Aged. In particular, I want to mention some of the evidence that has been drawn to the Minister's attention time and again by the fair rate for care campaign. There is overwhelming evidence that the care system—not just the care home sector but the home care sector—is reaching a critical point. Indeed, as the Minister herself pointed out, since the care home market peaked in 1996, the number of care home beds has declined. The Prime Minister said during last week's Question Time that we have lost 19,000 beds, but I suspect that, on the evidence from Laing and Buisson, the figure is higher. I shall not get into the semantics of whose figures are most accurate.
The fact is that registrations have plummeted and deregistrations have rocketed in the past five years, which is why we have a serious problem with capacity across the sector. Having listened to today's exchanges across the Dispatch Box and the Minister's response to the Conservative Opposition motion, my feeling is that this remains an issue on which the Government are being remarkably complacent. It is almost as if the Government want a loss of capacity in the care home sector. Ministers cannot be unaware of the concerns that give rise to this debate. Through numerous Adjournment debates in the past two years, Members on both sides of the House have sought to bring to the Government's attention their concerns about the loss of capacity, the closure of care homes and the knock-on effect on the wider local health and social care economy.
"experienced a significant, but unplanned and unmanaged, expansion in the independent care home sector as a result of the use of an uncapped Department of Social Security budget throughout the 1980s."—[Hansard, 4 July 2002; Vol. 388, c. 508.]
Indeed, she has restated the point today. That expansion was certainly unplanned and unmanaged, but could not those terms be applied to what is happening now? To a considerable degree, the loss of capacity in the care home sector was completely unforeseen by the Department of Health.
Has the hon. Gentleman seen a recent report by the King's Fund, entitled "Partnerships under pressure", which acknowledges that partnerships are developing the whole systems approaches that the Conservatives failed to recognise at all? Crucial ways of working together to integrate health and social care are beginning to be developed. Is that not the way forward for this sector?
I agree that whole systems are undoubtedly the way forward, and I welcome the work being done to that end by the Local Government Association and the NHS Confederation. However, I regret the fact that the hon. Gentleman's Front-Bench colleagues appear to be pursuing individual quick-fix gimmicks such as the introduction of fines for local authorities that fail to facilitate early discharge from hospital. Such a provision misses the point entirely, and simply treats the symptoms rather than the underlying causes.
Does the hon. Gentleman realise that, in Royal Bournemouth hospital, for example, at any given time, an entire ward—some 30 or 40 beds—is blocked by this problem? Although we are anxious to have home care as well, that cannot be achieved because this Government have cut the social services budget in Bournemouth—a budget that was designed for this purpose—by £3 million every year since coming to power in 1997. How are we expected to stop bed blocking in the light of such cuts?
The Local Government Association has made a detailed analysis of the implications of the settlement announced in the Budget, about which we will probably get more details in the forthcoming comprehensive spending review. The 6 per cent. real-terms growth—we will have to wait and see how much of that will be passed on to council tax payers, rather than being picked up directly through the Exchequer—will not lead to anything like the improvements that Ministers claim. The reality is that the Government have considerably underestimated the cost of providing care, and I shall discuss in due course the Joseph Rowntree Foundation's report on that subject.
The hon. Gentleman is right: the shortage in social services resources is passed on to the care home sector and to other care providers. Indeed, that is an important reason for the loss of capacity across several different care sector providers. That unsustainable squeeze in fees over at least the last seven years—it predates this Government—has been a serious cause of the reduction in capacity.
The Minister was right to identify the introduction of the NHS community care legislation in the early 1990s as one of the triggers for the downward pressure by local authorities. The Conservative Government recognised that they had set in train a runaway budget funded through the Department of Social Security—as it then was—and they wanted someone to cap it. Central Government do not like to take responsibility for capping expenditure, so they turned to local authorities to do the dirty work for them. Over the past seven to 10 years, local authorities have been effective at their job, and that is why we see the current problems in the care home sector and well beyond.
Does the hon. Gentleman accept that Liberal Democrat-run East Sussex was, year after year, bottom of the national league tables for how much it paid the private sector, while it squandered millions of pounds on paying hundreds of pounds more a week for beds in its own homes?
I hope that, on this occasion, the hon. Gentleman will stay to make his own speech, which he did not when he made that point in an intervention on my speech in January, when we initiated the debate. The answer is the same as it was to the remarks of Mr. Butterfill. Social services were underfunded by the Conservative Government for far too many years. It is hardly surprising that Mr. Waterson can make that point. The reality is that since the Conservatives returned to power in East Sussex, matters have not significantly improved.
In January, I published evidence of the squeeze in fees. In the charitable care home sector, charities are having to make payments to top up local authority fees to provide decent care. That costs the charitable sector £185 million a year to provide decent pay and conditions for staff and decent quality care for care home residents. A recent letter from a charitable care home provider goes to the heart of the problem and states:
"The demand for nursing and residential care remains high—we don't have any vacancies in our London homes but at a rate of as low as £247 a week we cannot afford to continue. A week's stay in a Travel Lodge in London without any meals or service from staff will cost you in excess of £400, what does this say about how the Government value the care of older people in our society?"
That letter was sent to the Minister in May and is further evidence that the sector is underfunded and undervalued. We are trying to get care for the elderly on the cheap.
Standards are an important part of the equation and the Liberal Democrats were committed to improving them during the passage of the care standards legislation. Indeed, some research into the quality of life in residential and nursing homes gives serious cause for concern. A report last year by the British Medical Journal found that in a six-hour daytime period, in several care homes in both the public and private sectors, residents spent half their time asleep, socially withdrawn or not actively engaged. Only 50 minutes were spent talking or communicating, and fewer than 12 minutes were spent in everyday constructive activities. We must all be concerned that that is the quality of life that far too many suffer in care homes.
Last month, Rowntree published a report by the leading market analyst, William Laing, which found a £1 billion black hole in the funding of the care home sector. The Minister of State, Department of Health, Jacqui Smith, prayed that report in aid but did not say whether she supported the central thrust of its argument that the sector is under-resourced. Perhaps the Under-Secretary of State for Health, Mr. Lammy, can say whether the Government will seriously consider the model for costing care in care homes set out in the report, discuss it with the Local Government Association and representatives of the care home sector and start applying it. In that way, we might bridge the gap between what the sector says and what the Government say is needed to fund the sector properly.
Laing and Buisson also produced a local report for Birmingham city council, and I am sure that the Minister will be aware of it. In May, Councillor Susanna McCorry, the Birmingham cabinet member for social services and health, wrote to the Minister saying:
"63 care homes have closed in Birmingham and many more face an uncertain future in the current climate. The City Council does not have the funds to be able to support the sector to the degree that it requires in order to bring about stability. There is a potential crisis looming for Birmingham unless there is some immediate financial support forthcoming from the Government. In doing so, I firmly believe that this will boost the confidence of the sector and the City Council to work together to achieve the longer term goals that we have set ourselves."
That was in May.
Just last week, I received an e-mail from the Birmingham care consortium that said that more than half the care homes in the city have now declined the contract from the city council. As a consequence, many homes will turn away local authority-funded placements, exacerbating the problems of bed blocking in the city. That is one consequence of the underfunding of the system.
Low pay and morale and poor staff retention are also serious problems. Many people get better paid stacking shelves in Tesco or working in a local IKEA. Providing care is a demanding and stressful job and we are rightly talking about requiring that more staff are trained, with 50 per cent. trained to national vocational qualification level 2 by 2005. But what happens when better trained staff work in a low-paid environment? They take their skills elsewhere, to the NHS or another public sector employer. There is no money in the system to recognise that level of training in the care home sector. What do the Government propose to do about that?
The standards have been the final straw for many care home owners. That is not because they are wrong in principle, or indeed in many aspects of their practice—although my hon. Friend Brian Cotter was right when he asked the Minister about the lack of consistency in the interpretation of standards by inspectors across the country. It would be a serious weakness in the system if we had national arrangements for regulating and inspecting care, only to find that individual inspectors still had far too much latitude in interpreting them on the ground.
The Minister talked about the softly, softly approach that the Government announced at the beginning of the year to try to reassure the care home sector. The later implementation of many of the physical standards is certainly welcome, but removing the need to change room sizes until 2007 does not address the problem that care home owners face when they see their bank managers to secure the loan to pay for the changes. It does not alter the fact that care home owners are asking for loans to remodel their homes to reduce the number of beds and therefore to receive less income. Bank managers will laugh in their faces and certainly will not provide the resources to facilitate the changes.
I have already taken one intervention from the hon. Gentleman, so I hope that he will forgive me if I do not take another.
Another problem that is causing great anxiety is the massive backlog at the Criminal Records Bureau. Any new member of staff at a care home has to be checked before they can start working. We have been told that that requirement has been put back to
When I surveyed care homes earlier this year, it is no wonder that I found that seven out of 10 were considering refusing to take on local authority-funded placements and more than half had seriously considered closing their doors and going out of business in the past year. As the cabinet member from Birmingham told the Minister, confidence in the sector has collapsed. It is not only the poor quality homes that are closing but the homes that have invested in making changes to improve the quality of their facilities. They now have to pay more in interest charges to repay their debts and are struggling the most.
The crisis is widening and deepening because of the crisis that is also developing in the home care sector where there are similar financial and staffing strains. Over the past few years, there has been a significant change in who receives home care. To manage their limited resources, social services departments have tightened their eligibility criteria year after year so that they exclude all but the most frail and desperately dependent people from staying in their homes.
The Minister regularly trots out the fact that there are now more high dependency packages, but glosses over the fact that in the past five years, care packages have ceased for 109,900 people or they no longer receive care at home. That is a 22 per cent. reduction. What has happened to those people? Have they miraculously become independent? Do they miraculously no longer need any services? Or is it simply that their local authority has defined them out of eligibility for care? That is what the Government really mean by choice; it is no choice for people who do not quite qualify because their social services department cannot quite afford to provide them with the care that they need.
What has struck me most in all the debates on this issue is that Ministers largely ignored the problem until it started to hit the national health service. When the statistics on delayed hospital discharge began to rise, Ministers became concerned and wanted to do something about it. The announcement last autumn about extra cash was not really to deal with stabilising the sector but to do withtackling the Government's concern about the headline delayed discharge figure. It is nothing to do with choice—it is all about Government targets. The Government are concerned only about what they are directly responsible for and quite happy to leave social services to clear up the mess in relation to things that are not their responsibility.
Delayed discharges are just a symptom—the result of the pressure on the care system as a whole. The Minister says that we need a whole system approach, but it is not happening.
In the past two years, we have seen an 18 per cent. rise in emergency readmissions. People are being discharged prematurely because care home packages are no longer available for them. They turn up in accident and emergency departments, needing more care and support.
The Government have failed to take a whole system approach, and the Wanless report, which was published on the day of the Budget, said as much. I hope that in his reply, the Under-Secretary will say that funding is at the root of the problem. Higher standards are not cost free. We were kidded when the regulatory impact assessment to the Care Standards Bill implied that everything could be done on a cost-neutral basis. It was nonsense then, and it is demonstrable nonsense now.
Would it surprise the hon. Gentleman to know that the Minister of State admitted last week—only after a question that I tabled in March this year—that the regulatory impact assessment, which she signed off in December last year, was inaccurate in one very substantial measure?
That was part of the assessment, as far as I can tell. The estimated cost was given in the annexe as £52,000 per establishment, whereas in fact it was £52,000 per room.
The hon. Gentleman highlights one of the errors in the regulations relating to disabled people in care homes. The regulations to which I am referring concern care homes for the elderly. However, he is right, and the figures had to be withdrawn as a result of that error. They caused anxiety across the sector when they were published because they did not add up. They did not add up when the Care Standards Act 2000 was implemented and the regulatory impact assessment was published. The figures were partial and did not give a true picture of what would happen after the Bill was implemented.
We could continue to argue how much extra the social services sector does or does not need. The Government say that it is 6 per cent., while the SPAIN—social policy ageing information network—group and others argue for more.
The Government deserve credit for the Wanless report, which studied and analysed the case for extra investment in the health system. We supported the recommendations with our votes when the legislation went through. We believe that there needs to be a Wanless report for social care. Indeed, the Wanless report said time and again that there was a need for such an analysis, but it was not within its brief.
I think that that was what I just said, and I am glad that the hon. Gentleman endorses it. I hope that, despite the fact that Ministers have so far rejected that request, they will consider it. What do they have to hide? Why would they be concerned about having a detailed independent assessment of what is needed to provide quality social care?
I am sure that my hon. Friend is aware that in 1999 the Government changed the assessment of elderly people in the population from total elderly population to elderly population living in private accommodation. That put undue pressure on authorities with high numbers of residential homes and will continue to do so. While standard spending assessments are under review by the Government, is there not a case for them to take that factor on board?
My hon. Friend makes an important point. My hon. Friend Mr. Foster raised a point of order earlier today in which he said that a consultation document was published today which deals with some of these issues. However, only four copies were lodged in the Library and there was a long queue at the photocopier so that Members could study it properly.
I hope that the Minister will tell us why the Government have set their face against having a detailed independent assessment of the true resource needs to provide social care at the level that we expect.
In the meantime, we believe that we need to strike a different balance in the resources going into the health system. Unless we inject additional resources into home care and care homes, difficulties with delayed discharges and emergency readmission will continue.
I do not disagree with the hon. Gentleman's emphasis on funding. However, there is also a systematic failure that I have not heard mentioned in the debate so far—the belief that the private sector alone can pick up the problems of the care sector. We need to look at other forms of organisation, principally mutual organisations, which are growing around the country. That must be emphasised as a solution at the centre of the situation rather than at the margins.
I agree with the hon. Gentleman about considering how to develop new models for the provision of care, such as co-operative and mutual organisations. We want to explore this area, which is an interesting way to ensure that there is a wider choice in the future.
The Minister says that the seeds of today's crisis were planted with the unplanned, unmanaged expansion in the 1980s. However, Ministers today are presiding over yet another unplanned, unmanaged situation, this time a collapse. If they fail to address the concerns that have been brought to the House's attention tonight and in many previous Adjournment debates, they will, by their complacency and denial of the facts, show that they are more interested in facilitating the loss of capacity through stealth in this sector and much more concerned about the headline delayed discharge figures than they are about choice, care and the dignity of people in old age.
It gives me great pleasure to be called tonight, because I believe that I am the only Member of the House who carries on any medical practice. It always pleases me greatly to be able to enter into a debate about which I hope I know a certain amount.
How elderly people are looked after is of great importance to doctors. Many of my patients end up in the nursing or care home sector sooner or later, and it is important to me to know that they are being looked after properly. Right hon. and hon. Members may be pleased to know that a number of elderly residents who have moved off my list into care homes still write to me once a year to let me know how they are getting on. It has probably more to do with letting me know that no one has managed to kill them off yet than with any care that I gave them. They certainly seem to want to keep in touch with their former general practitioner, which is pleasing.
The majority of care homes give an excellent quality of service and live up to the expectations of many of their residents.
Nevertheless there are significant problems in the care home sector and we must not underestimate or belittle them. The trouble with tonight's debate is that although Mr. Burns was long on rhetoric and gave a passionate speech, to which I listened carefully, there was not a word about what his party would do in a similar situation. We heard only how terrible things were; there were lists of the numbers of places closing down and beds lost but not a word about what his party would do to address the situation, let alone to put it right.
On the other hand, Mr. Burstow gave a thoughtful and careful exposition of the problems. I have great sympathy with much of what he said; many of the problems that he raised were entirely correct. At least he had some sensible questions and suggestions as to how we might address them.
The debate is important and the subject is worthy of careful consideration; it should not be trivialised and turned into a party political rant. Sooner or later, many people in this place will probably need care of one sort or another in their old age. It is important to ensure that that care is of good quality.
We have heard that there was a massive expansion of care homes in the 1980s. Indeed there was. I was practising then and an amazing number of care homes opened up all over the place. To paraphrase the slogan from a well-known supermarket, "Pile 'em high, sell 'em cheap", those care homes, under the auspices of the previous Conservative Government, were packing them in and selling them cheap. Many of those homes were providing low quality care, in small and shared rooms, with low staff numbers, inadequate training and poor nutrition. The standards of care in some of those homes were horrifying. The bottom line was profit—massive profit for the owners, but not necessarily good care for the residents.
That situation was not universal; many homes did a good job even then. However, the Government are trying to ensure that minimum standards are available for all residents, so that they can expect a minimum level of care wherever they go. The only way to do that is to raise standards, but all that we heard from the hon. Member for West Chelmsford was that we must not introduce higher standards too quickly; we must rein them back and dilute them. We never heard which standards he wanted to dilute and rein back or which ones he did not want to introduce. Perhaps he wants to put partitions across rooms to make them smaller. Perhaps he wants to do away with lifts. Perhaps he wants to reduce the quality of food available to the residents. All that we heard from him was how terrible things were and how much bureaucracy there was; neither he nor his party made a suggestion as to how we could address the problem.
The vast majority of people who go into care homes do not actually choose to do so. Over the years, a large number of my patients have gone into care homes and I cannot remember one who said, "I am looking forward to going into a care home." The majority of them went into care because they or their families felt that there was no alternative. That is one of the problems that we have to face.
Many people would much rather have a different type of care. They would prefer to be looked after by their own family in their own home, close to their friends. It is a tribute to the Government that they are at least prepared to address that issue and to try to provide care packages for people in their own home.
As a GP, I think it is a tragedy when I occasionally have to send people to hospital, not because it is the right place for them but because it is the only place for them in the circumstances.
The hon. Gentleman refers to care in the home. The Griffiths report, suppressed initially by the Conservative Government, suggested that there should be more such care. Care in the home was introduced in the 1990s—the Conservatives eventually adopted the recommendation—but it is restricted by cash. Social services departments throughout the country would like to establish more care in the home but they cannot afford to do so. Does the hon. Gentleman think that the Government should give more money to enable that to happen?
Yes. Of course more money should be going into the health service in general. Of course more money is needed for social services. That is why my hon. Friend the Minister of State, Department of Health told us that there would a real-terms cash increase of 6 per cent. next year and, hopefully, in subsequent years. Of course it is important that we put more money into the sector. Of course there must be more money for social services. Of course we need more money for hospitals. There is no question about that. We are suggesting more money, but we do not hear anything from the Conservatives about more money—and we hear very little from the Liberal Democrats, who are long on ideas but short on delivery. Of course more money is needed. Labour is finding more money, but it is important to spend it wisely and carefully.
In our society, people are living longer, and that is right. Thanks in small part to people like me, people are living longer than they used to. Medical care is improving, as it should be. Many people will have a long and—I hope—reasonably fruitful old age, but they will need increasing levels of care.
The hon. Gentleman referred to the 6 per cent. increase promised by the Minister. Does he agree that the money will be swallowed up almost immediately. First, the increase in staff wages is approximately 3 per cent. Many local authorities have been offering care homes only half the inflation figure. Secondly, the regulations require more and more staff, reducing staff-patient ratios, so the money will be completely eaten up and there will be no improvement in care standards.
The hon. Lady makes a fair point and I would be much more sympathetic if she were able to explain how her party could deliver more than 6 per cent. At least the Government are putting in 6 per cent., although I agree that it will probably not be enough and that we will need to put in even more. The Conservatives do not plan to put any money into the sector, so how will they achieve improved standards?
During the 1990s, the Conservative Government awarded the social services real-terms increases, year on year, of about 0.1 per cent. At least we have put in considerably more than that. I entirely agree with the hon. Lady that the increase will be swallowed up by increased staffing, higher care standards and improvements to the homes, but it is much more than we are being promised by the Opposition.
Does my hon. Friend agree that one way of making the best of the available money would be to pool resources between social services, the health service and other partners in local health trusts, as in the pilot schemes initiated by the Government? Is that not a better way forward? We are finding imaginative and innovative ways of spending money wisely on behalf of our constituents.
My hon. Friend makes an extremely good point—as always. When I was a member of the Select Committee on Health, we examined the relationship between health and social services to try to break down what we described as the Berlin wall between social and health care. We considered how health and social services could pool budgets and work collaboratively in the community to deliver care packages. We made some sensible suggestions that the Government were pleased to address and to adopt. My hon. Friend is right: we need more of that collaborative working because that is one of the ways that we can deliver better packages of care in the community.
People are living longer and they will need longer periods of care. Local authority funds are stretched; their money will always be tight and we have to ensure that they can live within their budgets.
The costs of providing decent care will always be high, however. The main thrust of my argument is to explore what we can do to reduce dependency on the care home sector. As a GP, when someone goes into hospital, I do not think it is a success—to a large extent I consider that a failure. When I see an elderly person who is not coping in their own home, I do everything that I can to institute a care package in that person's home. If the nursing and social care facilities are available we can set up that package in the majority of cases. That work is unsung; it is not heroic or recognised. It is not even necessarily counted statistically. However, a vast amount of work is undertaken in people's homes—small amounts of nursing or social care, help from relatives and friends and so on—which can make a massive difference to people and can prevent them from having to go into a care home.
Perhaps the hon. Gentleman could develop that point. Does he agree that we need to make progress on preventive strategies? One of the main problems is that the cuts that local authorities have made in those low-level home help services have devastated the moves towards preventive care. People have to do more for themselves and are putting themselves at risk of falls; a person has mucky nets and falls off a ladder trying to change them. Every year, the NHS spends £1.7 billion on hip fractures. Surely, we could recycle some of that money to provide low-level preventive measures.
That is an excellent suggestion. The hon. Gentleman has made some sensible proposals during the debate. He is right. A person aged over-75 who suffers a hip fracture has only a 25 per cent. chance of regaining independent life. The majority of people of that age who go into hospital with a fractured hip will end up in institutional care, which is a great tragedy. With proper rehabilitation, intermediate care beds, step-down facilities and care packages in the home, many of them could be rehabilitated to their own homes, but often they are not.
Often, an elderly person may be coping nicely—although perhaps on the verge of early dementia—but if they are taken away from their home and put into hospital, they become institutionalised in almost no time at all. It is completely impossible for them to go back to their own home because they have lost the ability to cling on to their home circumstances and their little networks. When that goes, it is the end of their chance to be rehabilitated.
My hon. Friend is making a very carefully constructed speech, but no one has so far mentioned the other part of the tripod, which is, of course, housing itself. One of the major reasons why people return to hospital is not necessarily their mental condition, but the fact that they live in inadequate or inappropriate housing. The unsung heroes are often the home improvement agencies, which do very minor alterations, such as fitting handrails or handles on baths. That is where we need to invest. It is not rocket science and it does not involve huge sums, but steady investment in such work could make an enormous difference. Does my hon. Friend agree?
I entirely agree with my hon. Friend. That is exactly the sort of thing that we need to do; it is cheap, easy and quick. It does not involve huge waiting lists or create huge problems. It can often be done in a matter of days or weeks, and it can make the difference. As I have said, when vulnerable people lose contact with their surroundings, many of them can never live independently again.
As the hon. Gentleman is collecting good ideas, I hope that he thinks that it would be a good idea to return to a policy that was in place across the country when the Conservatives were in office: instead of delivering a month's block of frozen food to elderly people in their homes, more hot, cooked meals should be delivered daily. I have just had the experience of having no alternative but to place an elderly relative in a residential home simply because she could no longer cope with cooking a meal at home on her own. That is exactly the sort of thing that the hon. Gentleman is talking about in referring to the small things that make all the difference between life being sustainable independently and having to go into residential care.
I thank the hon. Lady for that very thoughtful contribution. I have a great deal of sympathy with what she says. I entirely agree that even a short daily visit from the meals-on-wheels service, providing a hot meal, can keep people more cheerful and gives them much more to look forward to each day than taking something out of the freezer and putting it into the microwave. Often the daily meal delivery is the only source of contact that an elderly person might get, tragic though that may sound. The daily visit from the meals-on-wheels service can make all the difference to the contact with the outside world.
A two-minute chat about something of interest can make the difference. Small, simple things such as that save money. Although it may seem as though money is saved by giving elderly people a month's frozen food, the overall cost can often be much greater if they have to go into a residential home instead of looking after themselves at home.
The hon. Gentleman is entirely right, but there is a further issue: diet and nutrition. There is evidence to show that a lot of the people who are delivered their meals in advance en bloc simply do not feed themselves regularly during the period that the food is intended to last them. Of course that has long-term effects and probably throws them back into the system.
Again, the hon. Gentleman makes another useful point. What he suggests is sometimes the case, but one hopes that the food provided by social services is of nutritionally good quality. I am sure that most of it is, but the hon. Gentleman makes a fair point: it is important that elderly people get good nutrition because, again, that can make the difference. Some research that I have done certainly suggests that many people—in particular, vulnerable elderly people—suffer from a form of malnutrition. They may not be calorie poor, but they are often nutrient poor, which can make a big difference to their mental and physical functioning and their overall strength and well-being.
Yes, the hon. Gentleman makes a fair point, but we cannot honestly blame the frozen food because many of those meals are of nutritionally good quality, provided that people also supplement them with other food of their own. Nevertheless, that intervention is useful because what matters is looking after people in their own homes and getting people through the hospital sector as quickly as possible and back into their own homes. That is the right way forward.
In Dartford, Darent Valley hospital, which is brand new, has fewer beds than the hospitals that it replaces, so there is greater pressure on those beds. That hospital will flourish and provide a good service only if we can reduce bed occupancy lengths and have a faster throughput of patients. Often the problem, as many hon. Members will be aware from their own constituencies, is that too many of those beds are occupied by those whose discharge has been delayed. That effectively holds up the system, slows throughput, increases the mean length of occupancy and therefore causes problems in the acute and casualty end of the system. That is very difficult to manage.
In the modern hospital sector, it is very important that hospitals are used for acute stays, lasting as short a time as possible, and that patients are moved through and into the community as quickly as possible.
I am particularly pleased that my hon. Friend Mr. Pond, who was in the Chamber earlier, and I have been working on trying to get a step-down, intermediate facility in his constituency that will provide 100 beds for exactly that reason. People can be moved from the acute sector to the intermediate sector for rehabilitation and step-down care before being transferred to a residential home or, preferably, back to their own homes. We need to encourage that sort of initiative, and I am pleased that the Government are supporting that type of project. It is important that we do so because we can take the pressure off the acute sector and the care home sector.
Clearly, we have a problem. I am not trying to diminish the fact that we have to face up to the problem, but it is what we do about it that really matters. I can honestly say that I have heard nothing from Conservative Members about what they would do about it. They have not produced a single solution or said what they would do if they were in this situation. They can rant and rave; they can make a fuss about what we are doing, but none of them has yet produced a sensible proposition. Liberal Democrat Members seem to have a rather more thoughtful approach, and I have been pleased to hear much of what they have said. I hope that they will be able to catch your eye later, Mr. Deputy Speaker.
I do not like to butter them up too much. My hon. Friend is right; it has to stop somewhere, but let it be said that we are an inclusive party and, if any Liberal Democrat Member wants to cross the Floor of the House and join us in our endeavours, they will be made very welcome.
The important thing is that society has to face up to the fact that we have a problem. People are getting older. The cost of care is increasing. Thankfully, standards of care are also increasing, which we must surely all applaud. It must be right that those standards increase. It must also be right that the staff are paid and trained better and that the facilities in some of those homes are dramatically better than they were 20 years ago. That has to be the way forward.
Clearly, money must be found and we have to find a way for the system to provide that sort of care. Clearly, we have to balance permanent, long-term care in residential homes with care in the community. All those things must be taken into account. That is why I am so pleased about this debate, and I hope that we can throw around some of those ideas.
We have heard a list of things to help reduce the need for people to go into care homes, but would there not be less pressure on those relatives and families who are trying to get a relative moved into a care home if there were more support for carers and a greater recognition of their role?
That is an excellent point. We need to give carers more support. The figures that I have seen show that carers save the country many billions of pounds a year because of the care that they provide. Of course that must be recognised. Often carers have given up their own careers, sacrificed their own family life and made huge difficulties for themselves by being carers, but many of them are pleased to have done so.
I agree with the hon. Gentleman that it is important that we recognise the enormous contribution that carers make and that we support them as much as we can. We certainly need to give them all the help that we can. If we are to produce sensible solutions to the long-term care problem, all of us—carers, social services, the health service and the Government—have to work together, so I shall be pleased to hear what my hon. Friend the Minister has to say later in reply to some of my remarks.
Order. Before I call the next hon. Member to speak, may I make a plea for shorter speeches? Many hon. Members are seeking to catch my eye this evening, and I am afraid that an awful lot of them will be disappointed if speeches continue to be so long.
It is a great pleasure to follow Dr. Stoate this evening. He seemed to spend a lot of his speech telling us that the Opposition had no suggestions, but he seemed to spend the other half of his speech agreeing that we were making fair points in our interventions. He can't have his cake and eat it. He seemed to be short on suggestions, but he seemed to understand the problems that were articulated so well by my hon. Friend Mr. Burns in opening this important debate.
Buckinghamshire is not the sort of place that one thinks of as being in great need. Mention of my constituency conjures up visions of leafy lanes and expensive housing: it is not the first place that springs to mind as having a problem. One would be completely wrong about that, however, since in common with the rest of the country at the moment, my constituency has an enormous problem with the sick and the elderly. Like other constituencies, Chesham and Amersham is suffering from a great crisis in the care homes sector.
In Buckinghamshire, there is an association called the Buckinghamshire Association of Care Homes—BACH. I do not know whether the Minister has come across it, but it has established itself as a very strong voice for the sector. I would like to put on record my gratitude to Peter Hall, Peter Beard, Georgina Rixon, Paul Fletcher, Graham Faulkner and particularly Councillor Hugh Carey, who have briefed me and my colleagues in Buckinghamshire and who accompanied us to see the Minister earlier this year about a large catalogue of problems. The Minister was courteous, but, sadly, powerless to stop the disaster that faces us all.
Over the past few years, there have been substantial changes in this sector: mounting labour costs, new standards and regulations, and a lack of confidence in the future viability of the care homes market. Most of those problems can be laid at the feet of Government. If I am generous with my interpretation, I would say that the Government have tried. In reality, however, they do not have the foresight, experience or expertise to realise the unintended consequences that their actions have caused.
The national minimum wage, the working time directive, increases in pay awards to NHS nurses and staff shortages—of nurses, care assistants and domestics—are all wreaking havoc. The other day, a constituent told me that the care home in which her husband now lives starts putting residents to bed at 3 pm, as there are often only two staff to put 16 people to bed. What a humiliating ordeal for people in their final years.
The new standards and regulations, as we have heard, have rolled over the care sector like a smothering blanket—new national minimum standards, codes of practice from the General Social Care Council and European legislation. Individually, they make great sense and afford protection, as many people have acknowledged. Put together over a short period, however, they have had a disastrous effect—forcing local authorities to withdraw from running residential care homes, and closing non-compliant homes that could not cope.
The Minister may be aware that the National Society for Epilepsy is based in my constituency. It has written to me, stating:
"The new national care standards place considerable pressures on care homes to upgrade accommodation."
Indeed, the NSE has evaluated that it will cost some £15 million to put the establishment in my constituency into the condition now required by the Government. No one can argue with the aims of the new standards—they are highly commendable and have the best interests of clients at their heart. No money has been allocated, however, to enable care homes that are already under financial pressure to undertake the required improvements. As a result, care homes are closing because they do not have sufficient funds to enable them to meet the new standards. Other care homes are having to draw on reserves to enable them to undertake the work, but it is putting them under increasing financial pressure. As far as the National Society for Epilepsy is concerned, the £15 million that it must find will come out of money that could be spent on valuable research.
In addition, the care standards require higher levels of training for care staff. By 2005, 50 per cent. of all staff will be required to have achieved NVQ level 2 or above, or be working towards that qualification—all at a cost to the organisation. That is in addition to a raft of other mandatory training on moving and handling, fire, food and hygiene. Furthermore, all housing managers will in future have to have a registered manager's qualification or equivalent. The Minister must appreciate that the training will be very costly and time-consuming. Again, nobody can argue against the desirability of having those standards. The demands that are being put on the sector, however, are virtually unbearable.
The lack of confidence is only too apparent. Investors and corporates are increasingly viewing the care homes market as financially unstable and offering insufficient returns on capital invested. Many voluntary and charity operators are also adopting that view. There have been massive bed losses—whether the loss is 50,000 or a net loss of 19,000 is irrelevant. Not least because of this Government's drive to concrete over the south-east, existing home owners are finding that a higher value is placed on their land than on the business that they operate. Selling for housing development causes less sleepless nights and puts money in the bank. Private and voluntary operators run 85 per cent. of the care home market; if there is little incentive for them not to sell up and withdraw, what will happen?
What has been the effect on the care homes market? Over the past five years, local authority fees have fallen below open market fees. In Buckinghamshire, the usual fee is running at approximately £100 a week down. The budgetary and central Government restraints will not enable our local authorities to purchase bed spaces at levels necessary effectively to reduce delayed discharges in hospital services such as respite and intermediate care.
Many care homes survive because their private-paying clients subsidise the lower fees paid by the state-funded clients. However, voluntary sector and charity operators estimate that they subsidise local authority-funded clients in their homes by about £185 million, and that will prove to be a problem in itself. The Charity Commission has stated that charities such as the National Society for Epilepsy cannot use their funds to finance the care costs of local authority-funded placements.
For many years, the NSE, like many other care providers, has consistently subsidised the provision of care services, because there has been insufficient funding from Government and local authorities and thence to care homes. In the case of the NSE, that has meant subsidies of about £1 million per annum in recent years. The Charity Commission has made it clear that such subsidies constitute an illegal use of funds, and that means that charities cannot use charitable funds to subsidise what is a statutory responsibility of the funding authorities.
That has led the NSE to review its fee structure and, in turn, led to detailed assessments being made of all residents to ensure that individual fees realistically cover the level of care provided. The average increases are about 40 per cent, but I am sad to say that some are much higher. In some instances, 100 per cent. increases have had to be made. Throughout the year, the NSE has negotiated with local authorities across the country to introduce the new fees and it has largely been successful. It has skilled negotiators. However, the negotiations are still going on with some authorities that continue to claim that they are underfunded themselves.
In some instances, the fee increases are for residents who have been at the NSE for many years—some for several decades. Some authorities have threatened to move residents of long standing by saying that they are able to provide care more cheaply elsewhere. But are such decisions being made in the best interests of the clients, or are they being made purely on the ground of funding? I hope that the Minister will answer that question, because some funding authorities appear to be using clients as pawns.
According to the NSE, there is a lack of clarity between health and social services. Up to 70 per cent. of the subsidies made over recent years have been to cover the health needs of individual clients. Fees are currently paid by the local authority which, in turn, claims the health component from the NHS via the local primary care trust. However, there are no clear pathways as to how that funding can be acquired. It is evident from feedback from local authorities that there are inconsistencies in the response from the health authorities over what constitutes health care for individual clients. Clarification and clearer pathways are required.
I also wish to mention fairer charging, because my local authority has raised the issue with me. The Government have required that all local authorities review their charging policies to ensure that those people on basic levels of income support plus 25 per cent. are not charged for non-residential services after
Buckinghamshire county council has put in £1.2 million of local taxpayers' money into the base this year to offset the potential loss of income through implementing fairer charging and I have to tell the Minister that —may well not be enough. As a result, it is likely that some people will pay more than they currently do, and some will pay considerably more. Those on modest incomes will be hit the hardest. Carers may decide that enough is enough and ask social services departments to take over the responsibility for caring. What will happen then? That will add stress to the system, and high costs now may mean that many individuals will have insufficient provision for their old age.
My county council is in crisis. Its standard spending assessment for the past two years was the second lowest in the country. In 1999–2000 and 2000–01, it was the lowest. Even in the year before—1998–99—it was the second lowest. Two nursing homes closed last year in Buckinghamshire—another may close shortly—and we lost 58 places as a result. Laing and Buisson says that by 2010 there will be a 16.9 per cent. increase in the demand for residential nursing places which by 2021 will be 51.8 per cent.
Buckinghamshire has an average number of older people, but that is changing. There is some variation in demand in different parts of the county, but beds for the elderly mentally ill are in short supply across the area. Overall demand for care home places will increase significantly. In 2006, cumulative growth demand since 2001 will be 7.3 per cent., which compares with the estimated figure of 3.3 per cent. for the rest of the United Kingdom. The growth is projected to rise by nearly 20 per cent. by 2011. Despite that, we have the second lowest standard spending assessment allocation. The shortages of beds will be most critical in the Chiltern and Wycombe area.
I could go on about the difficulties in gaining access to beds, their costs, the increasing delays in hospital discharges and the choices of which my constituents are deprived, but it is only fair to let other hon. Members speak. My constituents want dignity for the elderly in our community. The pressures on the county council, the charities, the residential homes and the families in my constituency are almost unbearable. I ask the Minister to halt the crisis and stop it deepening. I ask him to provide practical solutions to the catalogue of problems.
I am a fair woman and will say that perhaps the Government's intentions have been good, but the consequences have been disastrous. Sadly, Ministers appear incapable of taking responsibility. I welcome the Under-Secretary of State, Mr. Lammy, to the Front Bench for the first time tonight. I hope he will not add to the catalogue of shame created by his Government's policies on care homes and will rise above the policies that have been so damaging.
Frankly, the speech by Mr. Burns was a disgrace. The debate is important and anyone with an interest in care of the elderly would not take his view. When I finished my training as a nurse, I chose care of the elderly as my specialism because it is the most challenging, difficult and fulfilling sector of nursing care. That is also true of ensuring the quality of life for older people in our community, but the Conservatives reduce that to a mere issue. The motion refers to fees and standards, but the hon. Gentleman's speech was only about standards.
The hon. Gentleman should look at Hansard. I take issue with him on another matter, too. When asked what he would cut from care standards, he said that that was not what he was saying, but he cannot quote such sources and expect people to think that he is arguing for something else. Care homes are important and we need to have a reasonable debate on them. The debate has improved no end since he spoke, and hon. Members need to consider the problem properly.
We are not daft: we know there are difficulties. We participate in and assist our communities by working with Age Concern and nursing homes. There is an increasing number of older people in our communities and we are trying to understand the problems that that creates. I welcome the fact that they have better health care and live longer and happier lives. If this debate had been entitled "The quality of life for older people," we might have heard a slightly better contribution from the hon. Gentleman.
Even if some members of our community are having difficulties, there is another way to approach this debate, which is to be reasonable and honest, as we were in Crawley. We got together everybody in the care sector and talked about how we could improve the quality of life for older people, no matter whether they are in residential care or being cared for in the community. We included GPs and nurses from the primary care trust, representatives from the acute trust, social services, the Alzheimer's Disease Society, ethnic minorities, Health Watchdog, Age Concern and Carers UK, the son of an elderly person in a nursing home, a private care home manager and, to advise on benefits issues, Crawley borough council. I am glad to say that the Minister of State, Department of Health, my hon. Friend Jacqui Smith, also came to the conference.
What would the hon. Lady say to the Buckinghamshire Association of Care Homes, whose representatives came with me to see the Minister on
I thank the hon. Lady for her intervention, I think. I hope that I was demonstrating that there is another way to achieve something better. I achieved something better through that conference, and I should like to explain how its achievements are taking pressure off our care homes. Among other things, the Government gave several million pounds to increase fees in West Sussex, which were a difficulty. We had been campaigning on that issue to ensure that the county council could pay adequately for people's care. There are ways to campaign, and it is not a solution for care home managers simply to say, "I want more money." We have to be a bit more active to achieve what we want in our communities.
Like the hon. Lady, I have regular meetings in my constituency, and have done for the past 10 years, but I agree with my hon. Friend Mrs. Gillan that the meetings held in recent years have signalled the crisis in care homes which we are now facing.
It is for the hon. Lady to make her own representations to Ministers, and I hope that she is able to achieve something different in her community—a more co-operative way of working that I have found helpful. I do not say that it has produced everything that I wanted, but it has certainly ensured that we work together more closely and more effectively.
We looked at our priorities and at specific problems. Nobody is saying that there is no difficulty in the sector; that is precisely why we held the conference in Crawley. We were looking at solutions, not just shouting about the problems. Of course we had to listen to uncomfortable comments, and we talked about money.
Does my hon. Friend agree that the root cause of the problem was the previous Conservative Government? I was a councillor 10 years ago, and I saw the effects of their policies on the care sector. They brought in differential charging, which allowed private sector care homes to charge higher fees than local authority homes, and that led to the boom of profiteering at the expense of elderly people and forced local councillors to close residential sectors. Would my hon. Friend like to comment on that?
I thank my hon. Friend for making that point. Anyone who was a state registered nurse at the time could tell us that they were approached by several people saying, "I've got some money to put into this nursing home—would you be keen to head it up?" There would be no investigations into how committed they were—it was just about getting a figurehead so that money could be made. Of course that situation had to end—it was ludicrous and inhumane. So we moved on to think about solutions, and we came up with worthwhile proposals to help to reduce the pressure on the care home sector. The pressure is not caused solely by care standards—it comes from our relatives and friends who want to ensure that they are getting the best. Anyone would think that some strange organisation was attempting to put pressure on nursing homes. We want to ensure that our people have the very best in care.
One of the most important comments that the nurse from the acute sector made was that they have too many admissions from older people who have not had their medicines reviewed for a long time. They become unsteady on their feet and fall over, then—as my hon. Friend Dr. Stoate said—they become disoriented and find it difficult to go back to their homes. A lot of work is going on in Crawley to consider that issue with the PCT. The aim is to have a mobile team that goes around assessing older people in their own homes to ensure that they are on the right sort of medication. That is a practical approach to keeping people out of the care sector and reducing the pressure.
We know from our constituencies about the suffering that is caused by dementia problems. That cannot be cured just by saying, "Everybody must go into residential care." That is not the answer. Carers want to keep their friends and family at home so that they can care for them there. So we considered respite care—using the care home sector for shorter stays, so that the carer could have a holiday while their loved one was cared for by others for a while. Giving carers the proper rest that they need helps to ensure that people can be kept at home. It is important to provide extra care homes—fantastic facilities that give people a front door and allow them to receive the care that they need, such as having a hot meal during the day, being properly bathed and being cared for around the clock. We have one in Crawley and more are to be provided. Having a health partnership manager has proved to be enormously helpful in reducing the number of delayed discharges from care. The post is jointly funded by the trust and west Sussex social services.
All sorts of measures can be taken: improved joint working; increased capacity to deal with the increasing numbers of older people; more intermediate care; sustained funding increases that mean that is possible to predict increased finances, which we could never do in the past; improved discharge planning; and increased medical checks. There is plenty that we can do. Age Concern is setting up a new advice centre to help people to stay in their homes for as long as they possibly can.
I shall sit down now to allow other hon. Members to speak. I hope that the rest of the debate reflects our understanding that there is plenty that can be done and that solutions can be found; we do not have to return to trotting out the line that there is just not enough money in the care sector. If we are imaginative, we can do it, and I hope that other hon. Members are prepared to be so.
The House was interested to hear Laura Moffatt talk about the partnership approach that she helped to promote in her constituency. I am sure that the same is true in many other constituencies. However, I disagree with what she said about my hon. Friend Mr. Burns. He made a fine and impassioned speech, and I hope that it is placed in residents' lounges in care homes around the country.
One of the claims made by this Administration was that they would introduce joined-up government, but this area of policy is marked by serious discontinuity. We were told that the comprehensive spending review would introduce stable, generous and confident financial regimes for public sector services, but this area is riddled with one-off payments to meet continuing crises, with no sustainable solution in sight.
We have been told that the way forward is partnership, but the Government have proposed entitling one partner to fine the other, although not the other way round, and have passed a Bill enabling one partner, the NHS, to take over the other partner, social services, at the whim of the Secretary of State. We have seen substantial and welcome increases in the budget of one partner, the NHS, at the same time as we have seen unsustainable settlements for the other, social services departments.
The point where the two systems meet now has a name of its own: DTC—delayed transfer of care, which is an epitaph to policy failure. I want to speak from three perspectives—that of the NHS, social services and care home owners—and then outline a way forward.
First, on the NHS, cash for change has not solved the bed-blocking problem. I shall quote from the minutes of the North Hampshire Hospitals trust of
"There are now 60 Delayed Transfer of Care patients that are also causing pressure on staff. The number of long term delayed transfer of care patients was a cause for concern."
Those minutes concerned Basingstoke hospital, where bed blocking is still an issue. I asked the other major hospital that serves my area, which is run by the Winchester and Eastleigh Healthcare trust, about its experience. Its bed-blocking figures are down from last winter, but at the same level as a year ago, totalling 59. If one looks at the reasons why, one sees that the problem is not going away.
Last year, at the worst, there were 25 cases of bed blocking owing to lack of funding. That number has now gone down to one. However, there are now 17 bed blockers due to there being no vacancy in a nursing home, as against one a year ago. On top of those 18, there are three bed blockers because of no vacancies in residential homes. Thirteen are still looking for suitable placements and 12 self-funders either have no vacancies or are looking for suitable placements.
Cash for change will not solve that strategic problem of undercapacity. A series of one-off payments simply builds up problems for the future. In Southampton, for example, the top-ups that the city paid for discharges from acute beds in 2001–02 out of cash for change produced an ongoing financial commitment into 2002–03, which means that there are no top-ups in the current year. So one blockage—shortage of cash—has been partially and temporarily cleared, but the logjam has simply moved to the next bend in the river: shortage of beds.
That brings me to social services. Hampshire county council has a competent, caring department that is struggling to do its best with the resources available, but it is caught between the rock of the revenue support grant and the market realities of care home provision. I asked Hampshire county council how its expenditure on social services compared with its standard spending assessment. In 1988–89, it spent £1 million under its SSA. The next year, it spent £5.1 million over its SSA, and that has gone up ever since until this year, when the budget is £11 million over the SSA.
I know that SSAs are simply a means of distributing grant, but if a council overspends on social services, it must either underspend on education or put up the rates faster than the Government would like. If the Government were open about the matter, they would recognise that they are increasingly vulnerable to the accusation of the Joseph Rowntree Foundation and others that they have got that part of the settlement seriously wrong.
Of course we must develop intermediate care services in order to try to divert demand, and Hampshire county council is doing that. However, that is unlikely to be wholly effective, especially when one takes into account the most dependent and vulnerable older people who need nursing care. The demography time bomb is ticking away; the population of over-65s will increase by 3 per cent. by 2007, and the over-85s by 6 per cent. The demand for nursing home places continues to rise. Over the past three years, the number of publicly supported nursing placements has risen by 9 per cent.
While demand increases, supply is falling. All the underfunding has affected the market. Between April 2001 and March 2002, 252 residential beds and 103 nursing beds net were lost to closures. In the previous year, the numbers lost were 89 and 75 respectively, so the losses are accelerating. Specifically in relation to nursing homes, there has been a reduction of 400 beds over the past three years—about 10 per cent. of total capacity.
That leads me to my final ingredient: care home owners. They feel isolated and vulnerable. That wholly understandable emotion feeds through to their staff—who read the papers and listen to the radio—and of course to the residents and their relatives. There is now a crying need for stability and confidence, to which I shall return in a moment.
I received an e-mail on Saturday from my constituent Mr. Chalmers, who lives in Tadley. He said:
"What is causing care homes for the elderly to keep closing at the rate they are at the moment? . . . My elderly aunt aged 95 is now being forced to look for another home (3 in 2 years) as they keep closing and being sold off."
Like other Members, during the election I visited most of the care homes in the constituency and, in preparation for this debate, I returned to one, a well-run, 21-bed home with an owner-manager. To get to the bottom of the figures, I asked her what the costs were. Allowing for no return on capital at all, and allowing the owner-manager £35,000 as salary, the weekly costs are £348 per resident—£273 is paid by Hampshire county council for the residents whom it sponsors, with self-funders paying £375. That is an indefensible cross-subsidy. I have no objection to residents on low incomes who are sponsored by social services being subsidised, but they should be subsidised explicitly from the public purse, not by their fellow residents and their families.
The basic wages in the home are £4.50 an hour, with more for qualified staff. The owner would like to pay more, but she cannot. It is difficult to retain staff, given the buoyant labour market in North-West Hampshire. The owner is grappling with extra costs, such as those incurred by complying with new regulations on radiator covers. There are 42 radiators in the home, and she has had quotes of up to £10,500 to cover them. I am sure she will do so, but in the meantime she has had to build a new cupboard and buy more ringbinders to store the growing amount of paper she has to keep—circulars, regulations, staff assessments, residents' assessments and so on. I am sure that other Members have found that some owners are beginning to resent the growing number of better-paid people who check, supervise and monitor them and tell them how to run their business.
Has the person in my right hon. Friend's constituency suffered from the same problem as a care home owner in Exmouth, who contacted me to say that he and his wife, who own the home, and their daughter, the matron, have had a letter from the National Care Standards Commission, inviting them to apply to the Criminal Records Bureau for enhanced clearance. They have been given until
We must have sensitive and sympathetic application of the regulations if good people are to stay in the market. In Hampshire, there are homes that are having to remove en suite bathrooms to meet the space requirements, which cannot be right.
The argument that the crisis is less of a crisis because implementation of some regulations has been deferred sounds plausible, but is invalid if we want to achieve a confident care home market. For those who are not going to meet the standards for whatever reason, it simply postpones the day of reckoning and ultimate closure. Those who would like to stay want to know that staying in the market will be worth while and that fees will rise, as Mr. Burstow said.
Many owners need funding to invest, but the banks read the newspapers and are growing more cautious. An inadequate revenue flow will not permit home owners to borrow the necessary capital to fund changes. Earlier this year, at the behest of the Department, the personal social services research unit carried out research into the reasons for closures. It concluded that a number of factors were at work, but describe two as being "decisive" in the owners' decision to close—low prices and the belief that they would not increase sufficiently.
To sum up, there is a clear picture of continued increases in demand led by demography, coupled with a reduction in supply. Costs are rising and are likely to go on rising, driven by higher standards and better treatment of staff and residents. Insufficient funds, however, are being made available to meet market prices. The gap is far wider than the Government seem to recognise. The system survives by low returns on capital; indefensible cross-subsidy; underpaying of staff; moral pressure on families to top up funding; bed blocking; and delays in assessment.
Although the Government pay lip service to the need for a healthy and well-run care sector, they have not done enough to secure it. They should make crystal clear what they expect from the sector in the long term and clarify the role of residential and nursing home care in the overall scheme of community care. They should make it clear that they want good people to stay in the sector and that they want more good people to invest in it. They should work out the likely level of demand, and then, in discussion with local authorities and the industry, put a price on what that is going to cost. That should then be factored into the SSA so that the resources are made available. In the meantime, the Government should abandon their policy of taking social services departments into the NHS. They are not running the NHS efficiently, and I do not believe that they would do it any better if they took on extra responsibilities for community care.
It is legitimate to ask where the money should come from. I would shave it off some of the growth money aimed at the NHS. We simply cannot limp on as we are. That is not fair on owners, residents or staff, so I urge the Government to recognise the scale of the problem that confronts them and to come up with an effective response.
It is a pleasure to take part in this important debate, not least because I do so under the eyes of 22,000 older constituents and a vigorously active mother, who will no doubt scrutinise every word that I say. I shall speak for only five minutes in order to allow others to get in, but it is a pleasure to take part in a debate which has featured some excellent contributions.
It is worth pointing out that Sir George Young was the first speaker from the Opposition Benches who, in stressing the important issues facing the private sector, started to move the debate along a little and to recognise that health and social care are a system and need to be a partnership, and that all elements of that partnership need to work together. That view has not come over from earlier Opposition speeches, which characterises the Opposition's approach to the matter. They emphasise one part of the system over the other parts and miss the essence of what the debate should be about.
There are huge issues to consider and desperately important issues to resolve. In difficult circumstances, the Government are taking on the matter properly and working along the right lines. We have the national service framework for older people, which emphasises person-centred care, choice and respect for individuals. I believe that residential care can be a positive choice. I take issue with my hon. Friend Dr. Stoate about that.
The Government have emphasised investment in major resources for health and social care, and high standards across the entire field of care—in people's own homes, in the community, and in residential care, nursing care and hospital. They have emphasised partnership across the various elements of the public sector—health, county and district councils, and the private and voluntary sectors. They have emphasised flexibility in meeting the needs of older people, irrespective of who provides the care.
There are a host of issues involved, but the urgent imperative is to build a partnership culture, moving way beyond the sort of systems that were in place under the previous Government, to develop a robust working relationship between the public, private and voluntary sectors, and above all to place older people, their relatives and carers at the heart of the system, at the forefront of concern and at the centre of the debate.
We have faced a terribly difficult situation in Lancashire over the past few months. Various speakers have referred to that already. It has been a traumatic experience for hundreds of older people in residential care and their families. I hope that we are coming through that now. The clear message that Lancashire county council must have got from listening to older people and from the work of inveterate campaigners, such as Bob and Ann Trafford of Poulton le Fylde in my constituency, is that the public sector services that the council provides are of very good quality and are highly valued by the people who use them.
I hope that the consultation to which Lancashire county council will respond on
We are talking about huge cultural change. We need to ensure that local authorities and health services show evidence of progress in terms of sustainable partnerships and improved services that impact on people's lives. I very much hope that my hon. Friend the Minister and her colleagues in the Department of Health will maintain very close scrutiny of what is going on in Lancashire. On the basis of primary care trust areas engaging properly with the private and voluntary sectors, district councils and older people as firm partners, we have the opportunity to develop services and move on, but we need to maintain tight scrutiny of what is going on and to ensure that the system works in future and that it does so very well.
I am delighted to have the opportunity to take part in this important debate.
It is clear that we have twin national crises: the problem of care homes and the interlinked problem of bed blocking. We have heard about almost 50,000 beds being lost nationally, the problems of bed blocking throughout the country and the £1 billion black hole in funding identified by the Joseph Rowntree Foundation, but I should like briefly to consider the local scene in East Sussex and Eastbourne in particular.
Eastbourne has a high proportion of elderly residents, and we have the highest proportion of over-85s in the whole country. We have already been disadvantaged once by the standard spending assessment formula changes to which one hon. Member has referred. It is important to say, although it is almost a footnote in this debate, that care homes and nursing homes are a significant part of the local economy.
The problem has been growing for years and the number of homes closing has grown steadily. As I said earlier, we have been bottom of the league table in East Sussex for many years in terms of our payments to the private sector. At the same time, under the Liberal Democrats, millions of pounds were wasted year after year on the ruinous cost of keeping open homes run by the county council purely for reasons of political dogma. I have raised that matter over and over again in the House. I first did so in a 1996 debate to which my hon. Friend Mr. Burns responded as Under-Secretary of State for Health. Most recently, I secured a debate in late 2000 in which I raised many of these issues.
We know that the homes have been hit by a triple whammy: the low rates paid by many councils; the funding of new regulations such as the minimum wage and the working time directive; and, of course, the requirements of the Care Standards Act 2000. The direct consequence has been the growth in bed blocking, or delayed discharges. The other day, I saw a press release from the Minister of State, Department of Health, Jacqui Smith, in which she trilled about how wonderful things were and about how many older people would be able to leave hospital on time. That was not the picture that I saw when I recently visited my local district general hospital. It is doing all the right things; it has opened a medical assessment unit, which is doing very well, and has just officially opened a surgery assessment unit. However, all those efforts to make best use of resources are being distorted by the number of bed blockers in the hospitals.
The very latest figures, which I received only today, show that across the East Sussex Hospitals NHS trust, there are currently no fewer than 131 bed blockers. That is an enormous number, especially in the light of the already stretched resources of the hospitals. In the winter of 1999–2000, there was virtually no bed blocking at all, so it is a relatively recent phenomenon, one entirely presided over by this Government and produced by their policies.
I acknowledge that there has been some extra Government funding but it has not produced the desired effect. I am pleased that, under the leadership of Councillor Keith Glazier and his team, there is now much closer working with social services and other relevant agencies but the problem still shows no sign of improving; it seems to be continually getting worse.
As I have touched on already, the problem we had over some eight years in East Sussex was the Liberal Democrat administration, which, as I have explained, squandered money on its own homes. One that has closed is Parker House in my constituency. Despite the dedication and care provided by the staff there, it was not meeting the old standards, let alone the new ones.
By the time the Liberal Democrats were thrown out of office about a year ago, some 800 people had been assessed as needing care who were not receiving it. God knows how many had not been assessed. Now that figure is less than 200, and it is expected to be zero by the end of this month. For the information of Mr. Burstow, who spoke for the Liberal Democrats, the Conservative administration, despite a very tight budget, has increased its payments to the private sector by 8 per cent. above inflation in the current year.
These are not just dry statistics. I remember the case of the elderly lady who contacted me and whose husband was at home dying from cancer. She could get no help at all in looking after him and lifting him; she damaged her own back. I finally managed to get social services to take an interest. I received a very touching letter from the lady saying that she was grateful for all my help but by the time they had come to talk about a package or putting her husband in residential care, he had sadly passed away. One wonders how many such cases there are of which we are as yet unaware.
Only recently, we received the joint report on East Sussex from the Audit Commission and the social services inspectorate, which gave services zero stars. It included damning indictments of the previous Liberal Democrat administration—so damning in fact that a number of leading local politicians, myself included, have called for Councillors Tutt and Rogers to withdraw from public life as they were the ones who presided over that disaster. Typically, we have not received a word of apology or regret from either of those gentlemen. They have shown the same unwillingness to accept responsibility that they showed when they were running social services in East Sussex.
As I have said, it is a matter not just of statistics but of people's lives—cases such as the one to which I have referred and others that we may never hear of. Those are the real reasons why those councillors should go. If they had a shred of decency or responsibility, they would have left by now.
I am pleased to say that the new administration has put more than £4 million extra into the budget to support older people and to tackle hospital discharge, but the question that I still need the Minister to answer is how on earth the Government will tackle the fact that 131 people are still in hospitals in my area with no prospect of being discharged.
In the short time now allowed me, I would like to put the record straight. Mr. Burns told the House that three care homes were closing in Kirklees, which covers my constituency. The House should know what is happening in Kirklees. There are 14 residential homes and three of them are indeed due to be closed, but what is going to happen to them bears some examination.
One home is to be taken over by the Housing Corporation and will become 40 new flats for elderly people. It will include day services, a medical centre and all the ongoing help that those elderly people will need. The second will be turned into an intermediary care facility. Conservative Members have shown a great deal of interest in deferred discharge from hospital. People will be able to go into that centre to receive the assessment and help that they need after a period of ill health, an accident or a crisis in the home, and to move on to the sort of care that is most appropriate for them. So, to present this as a simple case of closure is inaccurate and wrong.
The House should also be aware of other facilities that are available in the area. I have already mentioned Moorlands Grange, which my hon. Friend the Minister has visited, and which represents the way forward for integrated care for elderly people. We need to examine what is taking place in Kirklees, where a whole system approach is being used. Moorlands Grange is a resource centre where people can have an assessment of their needs, then—properly supported—move out into the community and back into their own homes. We have heard much from Conservative Members today, but in my constituency 453 people received intensive care in their homes last year; this year, the figure will go up to 533, and we have set a challenging target of more than 850 people in two years' time. We are seeing a growth in supporting people in their homes, and that is the way forward. Let us use our homes for what they are best used for; let us keep people in their homes, where they are most safe and secure and feel most comfortable.
I welcome the Under-Secretary of State for Health, Mr. Lammy, to his debut at the Dispatch Box, which we eagerly await. I look forward to many other opportunities to debate with him in the future. I am only sorry that he is making his debut in a debate on a serious matter on which his Government have such a lousy record.
We have had a good debate, which was excellently and passionately opened by my hon. Friend Mr. Burns. In contrast, the response from Labour Members was the usual fake indignation, as if it were a bit of a cheek for hon. Members to raise this issue again tonight. I was particularly surprised by the comments of Laura Moffatt, who has expertise in this area. She knows how my own county of West Sussex has been coping exceedingly well in very difficult circumstances with one of the highest number of elderly people in the country, and how it received a two-star rating in the latest social services rating list.
I am afraid that we heard the usual complacency from the Minister, as well. She talked about scaremongering and said that, apparently, there were "too many" care home beds in 1996, and that we have had only a "small" number of bed losses since then. I would hate to see what she regards as a large number of bed losses. This is a serious problem. The ageing time bomb that we all face is perhaps one of the most significant problems affecting our constituencies today.
According to the Government Actuary, there were 7.8 million people over the age of 65 in 1996 and, by 2031, that figure will have risen by 60 per cent. The biggest rise will be among the over-85s, who receive no additional funding through the health authorities once they reach 75, but who incur many extra health costs. By 2007, for the first time ever, pensioners in this country will outnumber children under 16. A man aged over 65 has a 9 per cent. chance of requiring residential care for the rest of his life, or a 5 per cent. chance of requiring nursing care. For women, the figures are much higher: 13 per cent. and 37 per cent. respectively. That is why this is such a serious matter, and why we are quite deliberately raising it again in the House this evening.
By any measure, the population is ageing. However much we may do to enable older people to live active lives in their own homes, with the support of carers, relatives and social services, we shall still require a big increase in the amount of residential care and nursing care beds. In fact, the Office for National Statistics estimates that the number of places will have to expand by about 65 per cent. over the next 30 years just to keep up. That is a very different picture from that painted by the Minister, who still thinks that there are too many beds—especially, apparently, in Redditch.
It is absurd and bizarre that the trend in the provision of care home beds should be downward rather than rising to keep up with demand. We have heard the figures from Laing and Buisson: there were 575,000 care home beds five years ago; that figure is now down to 525,000, and 2,095 care homes out of 14,600 have closed across the country. We have heard stories, particularly from Ministers' own constituencies, of how beds are being lost week after week.
It is particularly absurd and disgraceful that the Government should be so dismissive about the problem and that Members should apparently resent our raising it here. There was the disgraceful contempt shown by the Secretary of State for Health back in March when, during Question Time, he described elderly people as being
"banged up in a care home".—[Hansard, 26 March 2002; Vol. 382, c. 691.]
Equally alarming has been the complacency of the Prime Minister who, only last week at his own Question Time, brushed aside the concerns of a number of Members by claiming extra money was going in, and that new regulations would not come into force until 2007, so it was all sorted—and in any case the loss-of-beds figure was only 19,000. As my hon. Friend the Member for West Chelmsford and others have demonstrated, that was absolute nonsense.
Of course, to the Prime Minister the cry of "Geriatric residential facility, geriatric residential facility, geriatric residential facility" may not sound quite as sexy, or be as good a soundbite, as "Hospitals, hospitals, hospitals"; but such facilities are no less important to the bigger picture of health care.
Where does the Prime Minister acquire figures allowing him to make his calculations? Laing and Buisson is the recognised leader in research on care homes and is retained by the Department of Health. The Joseph Rowntree Foundation report mentioned by the Minister, which was published only last month, repeated its figure of 50,000 lost beds in five years, and it reiterated that care homes for older people were underfunded by more than £1 billion a year—a fact that adds to the woes of social services departments throughout the country about which we know so much.
I believe, however, that the actual figure is worse. In my constituency, those running residential homes have decided that they simply cannot comply with the regulations and stay in business, and are therefore closing their homes. Alternatively, they are running down beds and not accepting new residents—but such homes are still counted as having full availability of beds until they have closed entirely, although those beds are not technically available. As was pointed out by my hon. Friend Mr. Waterson, and also by my right hon. Friend Sir George Young, all those numbers represent real lives. Of course being shunted around three homes in the space of two years will affect the health and well-being of elderly, vulnerable people.
However, the situation is much more complex and worrying than either the Prime Minister or the Minister is willing to admit, and it does not help to reduce it to a dishonest, political numbers game. The problem is caused by a combination of factors: additional and in some cases excessive regulation, a shortfall in funding through local authorities, declining margins making the whole business less attractive at a time of rising property prices—a decline caused by increased costs of regulation, increased staffing costs and staff shortages—and pressure on social services, along with shifting responsibilities.
Let us begin with the problem of regulation. The Care Standards Act 2000 started with good intentions, but has succeeded in driving some of the best homes out of business simply because they operate in older buildings that would prove prohibitively expensive to convert by 2007. That is certainly the case on much of the south coast. We heard about the rise in land values from my hon. Friend Mrs. Gillan.
Larger room dimensions, single occupancy, en-suite facilities and the radiator covers mentioned by my right hon. Friend the Member for North-West Hampshire are desirable—but the time and attention given to residents by staff, the conditions available to them, the quality of their food and how well their medication is dealt with are what count.
Does my hon. Friend agree with my constituent Mrs. Diana Self? Writing about her grandmother, she observed:
"Elderly people don't care very much about ensuite bathrooms, single rooms or dimensions of lifts. They do care about friendly gentle care . . . and someone to hold their hand when they don't feel well. The outcome for her"— the grandmother—
"seems uncertain—the move may kill her".
Does my hon. Friend also agree that if the Minister's contention was correct, and if old people's choices were indeed at the centre of policy, there would be far fewer closures and far more people living happily in the same homes?
That is a good point. What makes the difference is whether people are in an all-round caring environment geared to provide a home life for elderly residents, or merely on a conveyor belt for those who are no longer able to look after themselves.
I received an e-mail from a nursing home owner in my constituency who has been running her business for 20 years. She says
"Care is the most important ingredient of a Care Home . . . Larger rooms wider doors etc will not improve care."
How right she is. The problem is that the regulations are too inflexible. They do not differentiate between quality care homes and those that simply provide a service—homes that happen to have the right environmental specifications, but without the right care environment. To add insult to injury, Anne Parker, chairman of the National Care Standards Commission, warned owners who are unable to comply with the new standard to
"start preparing an exit strategy."
Some solution! On the shortfall in funding, a nursing home owner in my constituency pointed out that the suggested amount for a nursing home bed is £460, yet our local West Sussex authority pays the not untypical rate of £375. As she says:
"We cannot continue subsidising these people."
There are big differentials throughout the country. In Islington, for example, the Government's elderly residential standard spending assessment per resident is £917, yet in Kent it is £351. That leads to distortion in prices and to London boroughs placing their residents in care homes on the south coast, thereby pricing local people out of the market. Local people will be unable to live in care homes near their families and near where they were brought up, thereby adding to their vulnerability in old age.
Some 80 per cent. of care home costs are staff costs. The minimum wage alone added £90 million to those costs; according to Sir Jeremy Beecham, of the Local Government Association, national insurance increases added £300 million; and BUPA added £50 million. Of course, none of that money was refunded through additional spending on the national health service. That will have a big impact on the 5 per cent. margin on which many independent home owners operate, and on their viability.
Staff shortages and the consequent reliance on agencies is leading to great increases in the costs payable by such homes. For example, in the north of West Sussex, an unqualified 18-year-old can walk into a job at the Gatwick airport branch of Burger King and get paid £6 an hour. However, some care homes down the road can pay only £4.50 to £5. It is a no-brainer. An added problem is the bureaucracy associated with vetting by the Criminal Records Bureau. As a result, those who would work in care homes have to wait at least 13 weeks. In the meantime, they give up and go elsewhere.
It is little wonder that many people in the care home business are giving up the ghost, taking advantage of rising property prices and converting their care homes into luxury apartments or back into family homes. Pressure is being applied to social services departments that are already suffering through the accumulated shortfall of £1 billion. Eligibility criteria are being tightened in most social services departments throughout the country. Two thirds of local authorities predict that they will be unable to look after the same number of residents next year as this year. For many authorities, it has become more a question of shifting responsibility between local authority departments and the health services.
As Mr. Dawson said, we certainly need greater working together, but the Government's only response is to fine local authorities that happen to have high bed-blocking figures. What impact does the hon. Gentlemen think that that has on working together in partnership? It is the good social services departments, many of which achieved a three-star rating, that have the greatest number of delayed discharges in their areas. That shows that the problem is not their fault, but one of the Government's own creation. The Government should solve it, but they are failing to do so.
This is a crucial and complex problem that demands much more serious attention from Ministers on all fronts, rather than the complacency and contempt that we have seen from the Prime Minister, the Secretary of State and the Minister. All hon. Members have an increasing number of elderly constituents, and however sophisticated we become at looking after people properly in their own homes, more care home beds will be needed over the next 30 years. A measure of how in touch we are with our constituents, and how effective we are on their behalf, is the concern that we show for our older citizens, translated into practical action to make their lives more comfortable and to allow them to live with dignity and choice.
For all the show of fake concern and indignation by Labour Members, we have heard nothing from them to give a crumb of comfort to any of our elderly constituents that this Government are doing anything to address the problem. Yet again, we see a Government in denial, who claim credit for every success, but who say, "Not me, guv" in respect of every problem. This is a growing problem that will not go away, and they could make a start in grasping the magnitude of it by backing our motion.
I am grateful for the opportunity afforded to the House to debate this serious subject, but it is unfortunate that Mr. Burns chose to raise it in such an appalling manner. His tone was completely out of place and, frankly, he showed his disrespect for elderly people.
As my hon. Friend the Minister made clear in her opening remarks, the Government intend to create a system of care that offers choice to those who need it. Opposition Members seem incapable of grasping that point and we have seen tonight that they are preoccupied with scaremongering.
It is worth reminding ourselves how we got into this position. It is important to remember that we experienced a significant but unplanned and unmanaged expansion in the independent care home sector as a result of the use of an uncapped Department of Social Security budget throughout the 1980s. That led to the unnecessary and completely avoidable admission of many older people and others into institutional care. From what Opposition Members have said, it is clear that they believe that elderly people are always best placed in institutional care. They do not understand that there are many modes of care—
The hon. Gentleman misses the point. [Interruption.] I intend to assist him with the answer in the course of the debate, if he will let me make some progress. [Interruption.]
There are many modes of care and ways of entering care for our elderly population, and that is the major thrust of the Government's policy. I agree that some people will of course always need residential care, and we need to ensure that they get it. However, the Opposition have been all too quick to scaremonger about the crisis in the home sector. Their approach is at best cynical and at worst schizophrenic. Much of what they talk about requires investment in the NHS and our social care system, but how did they vote on the Budget? They voted against that investment.
Care homes have always closed. The Opposition choose to ignore the fact that new homes are opening and existing homes are expanding. Some 31,000 new beds have opened since 1997. That is a 4 per cent. drop, which roughly matches the figure in 1997.
The Conservatives' focus is in the wrong place. We need to move the debate on from the sterile argument about numbers to the challenge of delivering a full range of social care services to meet people's needs. There is undoubtedly a need for residential and nursing care, but it is one of many options.
We are supporting more people to live at home than in the past. For every 1,000 older people, 82 were supported to live at home in 1998–99 and by 2000–01 the figure had risen to 84. That includes people receiving support in the form of home care, community equipment, home adaptations and repairs. My hon. Friend Laura Moffatt talked about partnership and the ways in which care is provided in the home in her constituency. The number of contact hours has increased.
It is up to the local authority to talk to inspectors and others. I cannot guarantee what the Conservative local authority does in the hon. Lady's patch—that is not my job.
According to the independent care consultants, Laing and Buisson, there has been a drop of about 19,000 places since 1997, which is a far cry from the figure of 50,000 that some hon. Members were bandying about but which Front-Benchers have chosen to drop. [Interruption.] Oh, they have not dropped it. That is another example of schizophrenia. We have no policy from the hon. Member for West Chelmsford, who cannot decide what he has or has not said.
The hon. Member for West Chelmsford made an appalling attack on minimum standards for elderly people. It was quite unbelievable. What do Conservative Members have against minimum standards? They cannot be compassionate Conservatives without believing in some minimum care. It is a case of the emperor having new clothes but not bothering to check the quality.
Minimum standards are important. Conservative Members claim that the care home sector has been thrown into crisis by the introduction of the national care standards. That is an extraordinary suggestion. Do they oppose the introduction of training for staff in care homes? [Hon. Members: "Yes."] Do they oppose medicine management for all and personally managed care plans? [Hon. Members: "Yes."] Clearly they do. So if the answer is yes, they oppose—
The hon. Gentleman did not give way during his speech. I have given way twice and I should like to make some progress.
If the Conservatives' answer is yes, they oppose the introduction of standards to ensure that users, carers and relations can have confidence in the quality and safety of the care that older people receive. Before the Care Standards Act 2000, care homes were regulated by 150 authorities, often with different standards. In the absence of proper checks on individuals, there were many, many cases of the most appalling abuse. Members will be aware that the most appalling physical and sexual abuse was committed in some of our care homes during the 1980s and 1990s.
Standards will guarantee the best care for the elderly in our community.
Will the Minister tell the House what is compassionate about a standard that causes a home to close when none of the residents needs the introduction of that particular standard? What is compassionate about that?
Homes are not closing as a result of the standards—[Hon. Members: "They are."] Hon. Members raised concerns about certain environmental standards and we have made it clear that those standards do not have to be imposed until 2007. We are open to looking closely at that matter.
Tonight, the Opposition have tried to delude us into thinking that they have suddenly become the party that cares about the vulnerable. That journey began when the Leader of the Opposition turned up in the inner city, in Hackney, to take his path of compassionate conservatism. After 18 years of Tory rule, no Labour Member will take lectures from the Opposition on that.
We remember the 2 million pensioners who were living in poverty on £68 a week when we came to power. We remember the VAT on pensioners' fuel—[Interruption.] We also remember—[Interruption.]
We also remember the Opposition presiding over a growing gap between the poor and better-off pensioners between 1979 and 1997, when the incomes of the best-off fifth of pensioners rose by 80 per cent. while those of the worst-off fell by more than 30 per cent. We shall not accept lectures from Opposition Members about the elderly.
We are certainly not going to take lectures from the Opposition about investment when they voted against the investment that we intend to make. We are proud of our record in helping the elderly and the vulnerable. We are proud of our free eye tests for the over-60s, which the Tories had abolished. VAT on fuel has been cut, helping pensioners to heat their homes. We are proud of our free television licences and other things.
On the care sector, when the Government—
Question accordingly agreed to.
Mr. Speaker forthwith declared the main Question, as amended, to be agreed to.
That this House welcomes the Government's strategy for modernising social care services through unprecedented real terms increases in resources; condemns the Opposition for opposing this investment; welcomes the improved joint working between the NHS, social services, and the independent care sectors which has seen a reduction in levels of delayed discharges of over 1,000 since September 2001; recognises Government action to provide real choice for older people in long term care and to place a greater emphasis on users and patients in the design and delivery of services; notes the confusion, inconsistency and lack of independence in previous registration and inspection regimes and welcomes the Government's national framework for standards and quality; further notes that the extra funding is enabling local councils to increase fees paid to care homes and that providers are continuing to open new homes; and recognises that the number of people receiving intensive home care support is increasing, enabling more people to live independently at home for longer.